16-105376 A. t, � VE® PERMITP
CITY OF �,�, '' PLICATION
PER
2016
Federal Way NOV 08MIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +peiulitcenter@cityoffederalway.com
CITY OF FEDERAL WAY /
TO
PERMIT NUMBER f _ ( U '7 ( _ 1- L ) i ) 8 1 ) (,
TARGET DATE G'
SITE ADDRESS SUITE/UNIT#
28'1/'/ I1 711 PL s 980a3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ /40D '7 2 C 5 7 0 _ 0 0 C.
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAL El DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT V))L l M I 1 1'Ck
r-ep14€4 5)J. plate CO AL fdA, 014.....
PROJECT DESCRIPTION
Detailed description of work to /lei,/ reP
` S/4� ,
be included on this permit only CLQ M4)C er- p td"�Q Ip-
NAME PRIMARY PHONE
Joh) t /LL/iii 'VI 295- S z4
PROPERTY OWNER MAILING ADDRESS E-MAIL
z_e q,I q 11 Te{ Pt- S .113.14N 5rV/tf,cow
CITY ( S ,
/1 ZI' 9 'O3
Fede.. �✓tir �T
NAME PHONE
r'OI.�^e/ *----
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME .... PRIMARY PHONE
W/ ba•E 9*9 z9r sz /e
APPLICANT MAILING ADDRESS E-MAIL
2t4Y;f /'I TH 04- $ JL) J s ai41Nr.ca—
CITY STATE ZIP FAX
Fea0-41 wk y kr4 gv003
NAME , PRIMARY PHONE
PROJECT CONTACT 0/1"1 L4I1' � 4�� 29s62.4/6
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 2.-gc(` I!R PL" 5 .too/ 4R././-7:cb(1•,
concerning this application) CITY STATE ZIP FAX
�V `)4/ k 1¢ 980o3
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: DATE ///4/12V/4
PRINT NAME: /�1 v1'I i,/ ' hI Lu M VRr
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application
• •
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS ( OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS 1CF -
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES 3 TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
LffKC � SEPTiL 7.
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKL R SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes No ❑ Yeso
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application
Plumbing
City of Federal Way Permit #:16-105376-00-PL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: WILLMORE
Project Address: 28944 11TH PL S Parcel Number: 720570 0080
Project Description: Replace water piping at kitchen sink,new prep sink and new waterline to ice maker.
Owner Applicant Contractor
JOHN WILLMORE JOHN WILLMORE OWNER IS CONTRACTOR
28944 11TH PL S 28944 11TH PL S
FEDERAL WAY WA 98003-3706 FEDERAL WAY WA 98003-3706
� -�7/%/6 '� �y��;?r J ��x §E �,�?L��!(/ .[(;F' /..� z�t f. � 50 / ✓/y /' '. � '��-.� r // �,�T'�/
� /'����'�, �,�1��d`�. � �� �o'i / t � ",i✓fir3'..�.a, :c�� �%,;;.���vt���. .f,ti ��.. .. ,,,,b ✓,,,:'a, ,N� �, ,� w' ? �3;
Other Plumbing Fixtures 1 Sinks 2
PERMIT EXPIRES Sunday,7 May,2017
Permit Issued on Tuesday,November 8,2016
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of
Washington and the City of Federal Way.
Owner or agent: Date:
i/104oi6 •
THIS CARD IS TO REMAIN ON-SITE , ,
Federal Way Construction Inspection Record
INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16 105376 00 Address: 28944 11TH PL S
Project: JOHN WILLMORE FEDERAL WAY WA 98003-3706
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible
(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if
you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
,
® Plumbing Groundwork(4190) ® Rough Plumbing(4230) El Final-Plumbing(4075)
Approved to cover Approved Approved
By Date By ,r,} Date 11`15 r`it 1By Date /
,
0 Rough Electrical ❑ Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date