04-104370 • •
City of Federal Way Plumbing Permit #: 04 - 104370 - 00 - PL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: CHURCH OF BLESSING
Project Address: 1430 S 330TH Parcel Number: 172104 9045
Project Description: Install kitchen appliances and fixtures
Owner Applicant Contractor
CHURCH OF BLESSING CHURCH OF BLESSING VICTORY CONSTRUCTION LLC *VICTOR'
31037 44TH AVE S 31037 44TH AVE S 31617 6TH AVE SW
AUBURN WA AUBURN WA FEDERAL WAY WA 98023
98001-2610 98001-2610 (206)730-7527
Plumbing Fixtures
Description Quantity Description JjQuantity Description Quantity
Dishwashers 1 Laundry Washer Outlets 1 Sinks 4
Water Heaters 1 2
PERMIT EXPIRES May 8,2005.
Permit issued on November 9,2004
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 w' h t - aws,rules and regulations of the State of Washington and
the City of Federal Way. _
Owner or agent: ,?95-' ��� Date: h/C,0
4114166
THIS CARD IS TO AMAIN ON-SITE d
CITY OF �� ,�� Community DevelopmNit Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-104370-00-PL
Owner:
Address: 1430 S 330TH ST
FEDERAL WAY, WA 98003-6302
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.
0 Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date # By Date By Date
��Final-Plumbing(4075)
Approved
By fri�� Date � j
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Y -T 2 5 2004 PERMIT SF MF CO ME EOD, EIV FP
COMMUNITY DEVELOPMENT SERVICES ,f
33325 8T"AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 980639718 f OF F f D
253-835-2607•FAX 253-8352609 V EOERI,AP P L I C AT I O N / �,,,� /
www.atgoffederahuaq con, RI,)II.DING Dr. 1( 8 / >l..,y
The following is required information-an in plete ap.lication will not be accepted. Please .rint legibly(in ink)Corr type.
,.., . PA PROPERTY INFORMATION .
SITE ADDRESS I/ i 9�y c D 3 571 F-F,-/, ii ot-i / SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# _- _ _ _ _ LOT SIZE(sf _
LEGAL DESCRIPTION(e.g.Acme Estates,Lot I)
(Attach separate page for lengthy legal desvipnon)
.,, ' V: `•.:: •.,., K. . -_' ' Z.--:' V:.PROJECT INFORMATION•
PECHANICAL
- ,TYPE OF PERMIT BUILDING 'PLUMBING
DEMOLITION 1 J ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
PROJECT NAME(Name of Business or Owner Last Name) e.-14,414(eyk ,1€551
":-'-'-'..-- -''.;'1':4:::--• .; - El PEOPLE INFORMATION a
PROPERTY NAME ?/' F-' ,
OWNER ! .'`, {re li 0 1- 1' e S sr PRIMARY PHONE
MAILING ADDRESS ,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME . OFFICE PHONE
tell('ICI
MAILING ADD CJIY STATE,ZIP CELL PHONE
3t� / 7 6 / v .$ L i e 1 - A,� / ` �-,.. '. ( - - - ) . .. -,115,,;
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER _ EXPIRATION DATE FAX NUMBER `
2 0 -U, -4 0- / Q5.7 Y .-B L I / ( )
CONTRACTOR'S REG RATION NUMBER(copy of card required with each applicatiouj EXPIRATION DATE
1i , / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
CI L,1 r c h. 0i 04 S-S t tk. ( )
MAILING ADDRESS C.1 CITY,STATE,ZIP CELL PHONE
(-i3o s '330 5 - r '/ Acyl (:oIt ) 730 --•72 7
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect [Tenant l�gent CI (, 3
Other(Describe) ) 66` -,( .j
CONTACT NAME �- PRIMARY PHONE E-MAIL ADDRESS
UiKInr ((5hef4 - Oc26 ) 7 - - 2-7,
LENDER PerI2CW95ertde2r Aformatiort is NAME
required f, ro i7gAti lue exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
f -, . ....; ',DI DETAILED BUILDING INFORMATION • .•-
EXISTING USE `}it SS!q, PROPOSED USE 1 /C'/1.0)1 7
• EXISTING ASSESSED/APPRAISED VALUE $ ) 7 5 0 00 U VALUE OF PROPOSED WORK $ 1 3, t✓ i,
SPRINKLERED BUILDING? ) YES ❑ NO FERE SUPPRESSION SYSTEM PROPOSED/REQUIRED? �ES ❑ NO
t WATER SERVICE PROVIDER /�J .K HHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER r HAVEN ❑HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS '
AREA DESCRIPTION EXISTING SQ.FT. PR. 4 SED SQ.FT. TOTAL
•
BASEMENT
FIRST 1'760 0 1 7 6 0
SECOND
THIRD •
FOURTH _.
ADDITIONAL FLOORS(DESCRIBE)
^DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING .TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
I •:`.. r e. i•.;: fltiei to «..- „�..,
{ - 4w- .;.t-,...,z s y.-n .,si '"'�5'i E.+i a+A`,' Z. F - -
S� ii1�fY y. .a•._�.. a.-ads...
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtu;', t• remain..
• MECHANICAL I I / i
Value of Mechanical Work $ _t V r,.lJ / i
AIR HANDLING UNITS EVAPORATIVE COOLERS G ',S / *1 .i R: • G.SY T
•FANS OO I;Cr,�,. /rual) F' ' WOODSTet"
'
BAS FIREPLACE INSERTS RAN 67 MISC(De-, .
BOILERSMGAS ATER HEATERS t 2
COMPRESSORS FURNACES t uJ
DUCTS GAS PIPE OUTLETS - �I Y
PLUMBING /MISE(Describe)(or T'b/Shoe,Combol SHOWERS - WATER CLOSETS IroiOq
DISHWASHERS 24 SINKS DRINKING FOUNTAINS
�. GAS PIPE OUTLETS SUMPS RAINWATER SYST
i WASHING MACHINES URINALS ,e''' HOSE HIBBS
LAYS(13w-‘,..m s sl VACUUM BREAKERS al ELECTRIC WATER HEATERS
W' l .,a rt i4'.•"`+s"`i ._- Hwy
1,44 i•rt x Z' . .�`c o- ISCLA ER/SIGNATQRE$LOCB _�_� , •
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 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.
t J
•
' r 5/��t'�l `}[` DATE 161 ;��
NAME/TITLE �/.K 0% •F'. , /5 h�'Ir.,,,:.,r.2./Pre (Intel
_ (Signature)
( RELATIONSHIP TO PROJECT 13 Owner Agent ❑ Contractor ❑ Architect 0 Other
- r
..., t .;• ,+cbak++a•z N i,
( F'OROFFICE USE ONLY
ci NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
i ZONING DESIGNATION CHANGE OF USE? o YES o NO
•
_NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? aYES a NO
• PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES a NO
J
I
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Bulletin#100-March 30,2004 Page 2 of 4