11-100512 CITY OF / 1 - / O O
Federal Way PERMITRerEFP
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607.FAX 253-835-2609
www.cituolTederalwau.com FEB 0'8 f P 41
SITE ADDRESS CITY OF
,L WAY
CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL!
TYPE OF PERMIT 0 BUILDING PALUBIBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT �`
(Tenant Name/Homeowner Last Name) S' LA.) li �'E J( ' " 2-Ci.
N p Or 1iv/ P) XTli12LS
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
•
NAME PRIMARY PHONE
PROPERTY OWNER „SrC V
MAILING ADDRESS E-MAIL
CITY STATE 1/`ZIP p ''
NAME J C �v/1 /VG
!•v (i�/ �✓(1 ��/
MAILL B Tern 1 S j! d \V( E-MAIL
CONTRACTOR I'4,03(.204)41-fG
CITY ATAt ZIP gvor 7
�[/ FAX
WA STgT$_lC_CO]yT71OR'f DENSE S, / A ,WDRait �t l/
FEDERAL WI7INESS LICENSE
NAME 5.ab l91 I
PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorised 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 authorised 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 arty 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: .r ./��j _ _. ,/ DATE 7�/
PRINT NAME:
Bulletin#100—April 14,2010 Page 1 of 3 k:\Handouts\Permit Application
.rt-;ti
VALUE OF MECHANICAL WORK $ (.P • • of bid or estimate must be provided) _
Indicate how many of each type o fixture to be install- located as ••• s poctt-ect. Do not include existing fixtures to remain
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FI:.•. INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCT GAS PIPING WOODSTOVES
c 4 s }, q ��A ' '*r,?q, ,}u fr , A
• . " ,,.
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) I d LAVS(Hand Sinks) C() TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS CAKC'tJLMZ`�anl)
DRINKING FOUNTAINS SINKS(Kitchen/Utility) I WATER HEATERS(Electric) 0II`tr'
HOSE BIBBS 1 SUMPS WASHING MACHINES TOTAL FIXTURES
CRITICAL AREAS ON PROPERTY? 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
..fikr. Ritg- Y NAS % rtio
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMI M.
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
D11♦CK
GARAGE 0 CARPORT 0
OTHER.(describe)
EXISTING PROPOSED TOTAL
— _..._.
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDIN+
ADDITIO
tom
Area Construction #of
AREA D -CRIPTION in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL • o DING
TENANT AREA ONLY
"AttEr�ONLY
Bulletin#100–April 14,2010 Page 2 of 3 k:\Handouts\Permit Application
City of Federal Way' O
Community Development Services Permit #: 11-100512-00-PL
P.O.Box 9718FILE
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax(253)835-2609 p q
Project Name: ST LUKE'S LUTHERAN CHURCH
Project Address: 515 S 312TH ST Parcel Number: 082104 9038
Project Description: Installing new plumbing fixtures in new church addition. Plumbing
Owner Applicant Contractor
ST LUKES LUTHERAN CHURCH J&K PLUMBING INC J&K PLUMBING INC
515 S 312TH ST 34127 183RD AVE SE JKPLUI*159RD(3/19/11)
FEDERAL WAY,WA 98003-4033 AUBURN WA 98092 34127 183RD AVE SE
AUBURN WA 98092
�., plum# 1
��'„•4.,',.. �� ��, � waAPPV �"� �� �� Irl 4 z,k"
Drains 1 Drinking Fountains 1 Lavatories 10
Other Plumbing Fixtures 1 Sinks 9 Water Closets 10
Water Heaters 1
PERMIT EXPIRES Saturday, August 6, 2011
Permit Issued on Monday, February 7, 2011
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 theCCi w of Federal Way.
Owner or agent: %.411.".., Date:NI ro
a ft (( 1
DATE, INSPECTOR AREA AND TYPE 01 ,'1SPECTION
c\--t I \ �,� �^ 411..Q.-.,
Q ., Fv z9_e e),
THIS CARD IS TO REMAIN ON-SITE
CITY OF • Construction I ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 11-100512-00-PL Address: 515 S 312TH ST
Project: ST LUKES LUTHERAN CHURCH FEDERAL WAY, WA 98003-4033
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.
o Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By 0.- -.11 Date
-15- ' 1 .By 1.9Date
O Final-Plumbing(4075)
Approved
ByJ G S Date G 1 - Ito- 1 j
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date