09-104555 "' • Pm' tubing
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City of Federal Way Q
Community Development Services Permit #: 09-104555-00-PL
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: CORTEZ
Project Address: 28632 21ST AVE S Parcel Number: 422200 0070
Project Description: Potable water piping replacement for bathroom/laundry area and kitchen sink.
Owner Applicant Contractor
DAVID&BEVERLY CORTEZ PACIFIC PLUMBING PACIFIC PLUMBING
28632 21ST AVE S PO BOX 5278 PACIFP*981CK(2/12/10)
FEDERAL WAY WA 98003 KENT WA 98064 PO BOX 5278
KENT WA 98064
amt,
Plumbing Fixtures
Other Plumbing Fixtures 1
PERMIT EXPIRES Tuesday, May 18, 2010
Permit Issued on Thursday, November 19, 2009
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.
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Owner or agent ` - Date:
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THIS CARD IS TO MAIN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 09-104555-00-PL Address: 28632 21ST AVE S
Owner: DAVID & BEVERLY CORTEZ FEDERAL WAY, WA 98003-3339
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.
0 Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) CI Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By Date By Date
I
❑ Final-Plumbing(4075)
Approved ,
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By 17/ f7Date 001
Rough Electrical Final Electrical 111Right of Way
CIApproved I=1Approved Approved
By Date By Date By Date
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253-835-2607•FAX 253-835-2609 D
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SITE ADDRESS _09..,... c�(CJ'3 — c;? ) ,._]
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
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NAME OF PROJECT CO(Tenant or Homeowner Name) / (It ri-Z__
❑ BUILDING " ),PLUMBING D MECHANICAL
TYPE OF PERMIT /`
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAMEr, PRIMARY PHONE
PROPERTY OWNER J�LI)'a (Q Il-z- r j, 3�/.j _
MAILING ADDRESS,CITY,STATE,ZIP , E-MAIL
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OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
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S _ N A MAILING ADDRESS,CITY,STATE,ZIP •
FAX
! ,1 ��1 tip. WA S E CONTRACTOR'S LICENSE �` / RP TIO E FEDERAL WAY BUSINESS LICENSE#
('A C,/V�' 9�lC � / / _ (l7/fi6C.
NAME 0 PRIMARY PHONE
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APPLICANT G� l�l4 1,- (•A i �e) L '/X!G' OK` j
MAILING ADDRESS,CITY,STATE,ZIPFAX
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PROJECT CONTACT NAME ,. PRIMARY PHONE
(The individual to receive and -, q-'7 ei.S c )e)13 _ ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19 27.095) ( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
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SIGNATURE: ---'------. 1' DATE ��
PRINT NAME: v (Af!4 -
Bulletin#100-4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
MECHANICAL FIXTURES
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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
PLUMBING 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.
BATHTUBS(or Tub/Shower combo) LAVS(Hand Sinks) TOILETS ' WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PP.ROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL
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 Construction # of
in Square Feet — Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application