07-100206 Ai } r
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City of Federal Way PlumbingPermit #: 07-100206-00-PL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 ' ' pi, tre? p Inspection Request Line: (253) 835-3050
-11
Project Name: DR BRIAN FILBERT FAMILY DENTISTRY
Project Address: 33507 9TH AVE S Bldg B Parcel Number: 926500 0020
Project Description: Plumbing for new dental office.
`
Owner Applicant Contractor
TONY STARKOVICH THE ROBSON COMPANY INC THE ROBSON COMPANY INC
VINTAGE CAPITAL INVESTMENTS 9531 NE 140TH ROBSO**055QA 10/25/07
1611 9TH AVE N BOTHELL WA 98011 9531 NE 140TH
EDMONDS WA 98020 BOTHELL WA 98011
Plumbing Fixtures
Dishwashers 1 Laundry Washer Outlets 1 Lavatories 2
Other Plumbing Fixtures 2 Sinks 12 Water Closets 2
PERMIT EXPIRES Sunday, January 18, 2009
Permit Issued on Friday, January 19, 2007
I hereby certify tha th_ above inf ati• is +orrect and that the construction on the above described property and
the occupancy a d th- use w. b: in -ccor®- ce with the laws, rules and regulations of the State of Washington
i•s the City'of Federal Way.
Owner or agent: ,, Date:_ I i‘:\ 01
THIS CARD IS TO&MAIN ON-SITE
CITY OF ommunitY p Inspection me t Ins ection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 07-100206-00-PL
Owner: TONY STARKOVICH
Address: 33507 9TH AVE S Bldg B
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. 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) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date ByC Date , . By Date
❑ Final -Plumbing (4075)
Approved
By G , Dates/, g 3' 07
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Pr ederal way JAN PERMIT SF MF CO ME E DE EN FP
C0109UNITY DEVELOPMENT SERVICES
200 'i
33325 Snt AVENUE SOUTH.PO Box 9718
2F5E3D8E3RAL
5267
•Y,FAXWA 29538086335-92761089 Y oF :e0E
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www.cituolfederalwau.com BUILDING
DEPT
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
M
SITE ADDRESS , /� / . /� l` 0 SUITE/UNIT#
ASSES'.OR'S TAX/PARCEL# / 5 _Q - ® 0 lI LOT SIZE(sf)
LEG• DESCRIPTION(e.g.Acme Estates,Lot 1)
r.,.. se.....•..e or leng/ legal description) 1111M10 r n r a
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ,PLUMBING VkMEOFLANICXL4
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu) /
1 (..A.` ri's LY i ti G. ��` —f�l'Z-3. "�'. 4 Q. i�Y�N.h xN k\L !A. t Ali y (._-
PROJECT NAME(Name of Business or Owner Last Name) i_12 (\iL) 7` 1 1 SGL ,
IN
PEOPLE INFORMATION ^7 ` 67,.... .....d_
,, C' �-
OWNER PROPERTY NAV T-o( ( . � (� d N7 /J t(/J �/
MAILINGi 'D ^ COY.9T1\, ATE'
Z� . „ ^na� E-MAIL ADDRESS
((JJ,`� (-.fl Cj—o�1{'. I-✓,�fY.\f��{^J (�`J oY
CONTRACTOR . rIPANY N n APPLICANT NAM OFFICE PHONE
( l� :_�� N �MV1 N Tut TL 1:214. (4 2`y S l.-1 -'i 3c,
LING
ADD t CITY,STTA�y,ZIP (`'��f•� a�.;r�� CELL PHONE G;
1 ` C likS� i e"E. -1 TION DA:CS?��, FAX NUMB i - Z L Z
C ' c FEDERAL r Y BUSINESS LICENSEQNNUMBERR F.XPI
0 �''P/d t,,, .'1 2 a--"'Z ( ) -
CONTRACTOR'S REGIS .' t ON NUMBERcz. EXPIRATION DATE E-MAIL ADDRESS
COPY of card required T�
with each appllcalloa f/� �j�. c� /0 v 7 � ,,�(�y , .( `ti,$a ACC, Ct/�
APPLICANT CC ANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT t)i '1\1 NI--10`i:.9.._,-,c1,; (`(•Z`;) 4 Vi e _--? t' /�
1�C,N ,(CiUS+hl+i%%'''' .:D-Ii 1..l�J2
LENDER
NAME Per RCW 19.27.095: 1Ct'•
. _ Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
• DETAILED BUILDING INFORMATION
EXISTING USE ( , PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $_ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
1—_- SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
0 PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ C (A COPY OF'BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVA,QRATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS }' HOODS(commercial)
COMPRESSORS FURNACES \��—RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS _'�`.4 t vl
r (`
PLUMBING bw(4- a.,(kms
BATHTUBS(or Tub/Shower Combo) L LAVS(Bathroom Sinks) URINALS I MISC(Describe) (j
1 DISHWASHERS RAINWATER SYST VACUUM BREAKERS �y�Ds ars&y o
DRINKING FOUNTAINS SHOWERS Tr WATER CLOSETS(rollet) r M� sl-44ot
ELECTRIC WATER HEATERS i Z• SINKS I WASHING MACHINES /'3 L.1 fl''''-`4„.„_____„, b l a{L„I,
HOSE BIBBS SUMPS /l J
SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 maybe made by any person,in uding the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reli c of the city,i clu n it officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. �]� �,p p
NAME/TITLE �j ��a1 C T 1`I(Po.�c �C PATE 11 1 ih -7
llgnatu (Title)
RELATIONSHIP TO OJECT 0 Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
i
l+OR07161610 9
❑NEW ❑ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YES o NO
Bulletin#100-January 1,2007 Page 2 of 4 k\Handouts\Permit Application