04-100392 0 5"
City of Federal Way Plumbing Permit #:04 - 100392 - 00 - PL
Community Development Services
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: CHURCH OF BLESSING
Project Address: 1430 S 330TH Parcel Number: 172104 9045
Project Description: Plumbing for new bathrooms,drinking fountain,and kitchen
Owner Applicant Contractor
CHURCH OF BLESSING CNC PLUMBING CNC PLUMBING
31037 44TH AVE S CNC PLUMBING CNC PLUMBING
AUBURN WA 33324 ELKHOLM DR SE 33324 ELKHOLM DR SE
98001-2610 AUBURN WA 98092
Plumbing Fixtures
Description Quantity] Description !Quantity Description jQuantity
Dishwashers 1 Drinking Fountains 1 11 Other Plumbing Fixtures 14
Sinks 11 Urinals !j 3 Water Closets ---= 7
Water Heaters 4
PERMIT EXPIRES August 16,2004.
Permit issued on February 18,2004
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 agen •-...r'�.1 :alio Date: //e/I/I
VI° a � “AL s-F- ,�; o�.,( Z•
1 �l
I
• COMMUNITY DEVELOPMENT SERVICES
crrr of�� 33530 FIRST WAY SOUTH•PO BOX 9718
Fderal y �� �Way CEIV MIT APPLICATION FEDERAL WAY,WA 98063-9718
253-6614115•FAX'253-6614129
unutiernho, con
For Office Use Only: !S VE1'fle IN inge4o 4_0 L. — —• 0' ^ `,111 01 (Z/-_ ) TD.
2 •-
The ollowin• is r-•1.4itt)d tri . . z. .n-art incom.lete a..lication will not be acce•ted. Please •rint le.ibl (in ink)or •e.
• ■ PROPERTY INFORMATION
SITE ADDRESS: /1 y20 � _ 36 - /,e.. a.,./71.7SUITE/APT#
ASSESSOR'S TAX/PARCEL 41: - SQUARE FOWT4 OA,OT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): ❑ BUILDING PLUMBING ❑ MECHANICAL 0 DEMOLITION
❑ ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT Da C- i• ION(Provide detailed descri tion o work included on this permit only):
u / Ea -P d L 60 iwr ' Al :ArI i t <.: d /A ..X.
(IL
PROJECT NAME(Name of Business/ wner Last Nam : r/it) /5/jD s'hi-7 2
• PEOPLE INFORMATION
PRIMARY PHONE:
x /OWNER / �( 't- r cXc/c , / �/ ) 3 0
����7
(MAILINGESSlSTR RISS nd CI JZ:Il.N.3 c-S' Jt . COV4", G// Q4/ 1O3
CONTRACTOR: NAME
ditie,,,‘
e C /,f ,,COMPANY OFFICE PHONE::: '�j D19/4:,,,/vA.:711
TR ) CI. .STAT .ZIP S-) " 3/ /0" 9
3���� ��(1�1/SJ$m ,/�/�h� �» C�� �� CELL PHONE: / 7
CITY•F D RAL WAY BUSINESS LICENSE NU fB / C AT10N DATE: )6 ) ��j - /3
FAX NUMBER:
- / / ( ) _
CONTRACTOR'S REGISTRATION NUMBER: /� tt pEXPIRATION DATE: �' ///
(copy of card required with each application)a e.'L y ls1 y .e /! I/ i*� / �/
LENDER: NAME: -( �1 L /L ( 9 0 /
(If Proposed value>$5,000) DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP -
APPLICANT: NAME: COMPANY OFFICE PHONE:
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING)PHONE:
RELATIONSHIP TO PROJECT:
FAX NUMBER:
0 Architect 0 Tenant 0 Other(Describe): ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner 0 Contractor ❑ Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION - .
EXISTING USE: !
■ PROJECT FLOOR AREAS i
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
--AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETSoizA-'�J 1 3
PLUMBING i.✓\ Z' `
BATHTUBS(or T„c/showorCombo) SHOWERS !6 WATER CLOSETS croiku MISC(Describe)
/ DISHWASHERS SINKS / DRINKING FOUNTAINS 1l(-it
Oul
GAS PIPE OUTLETS SUMPS RAINWATER SYS �
WASHING MACHINES — URINALS HOSE BIBBS „&'01.1(
� 1
LAVS(Bathroomsinlr VACUUM BREAKERS C 1 ELECTRIC WATER HEATER C )
till a 04/2A4 'L
■ DISCLAIMER/SIGNATURE BLOCK
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 thepermit
and
application is made. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses,
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 of Federal Way,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_
DATE: 1 --C'T
NAME/TITLE: ice. - ' �' - - _ature) (Title)
RELATIONSHIP TO PROJECT: 0 Property-•wner 0 Applicant 0 Contractor ❑ Architect 0
FOR OFFICE USE ONLY:
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o 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? o YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
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