14-100718 r I
• 0 Plumbing
City of Federal Way .,„ + /� Q (� D
Community&Econ.Dev.Services Permit #. 1'7-1 0071V—®V—1
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609 _ • Inspection Request Line: (253)835-3050
Project Name: JACOBSON,BRETT H DDS
Project Address: 1718 S 288TH ST Parcel Number: 332204 9109
Project Description: Install a reduced pressure backflow device
Owner Applicant Contractor
JACOBSON LLC B J&K PLUMBING INC J&K PLUMBING INC
1718 S 288TH ST 34127 183RD AVE SE JKPLUI*159RD(3/24/15)
FEDERAL WAY WA AUBURN WA 98092 34127 183RD AVE SE
98003 AUBURN WA 98092
Plumbing Fixtures
Other Plumbing Fixtures. 1
PERMIT EXPIRES Wednesday, August 13, 2014
Permit Issued on Friday, February 14, 2014
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-. f Federal Way.
Owner or agent:
z,..,;--,::,- ÷ .‘,-- ., `� , .��/ Date: f J 4-1-c
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FINALED
carr or :.,
THIS CARD IS TO ;MAIN ON-SITE
Federal Way
• Construction In, ection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 14-100718-00-PL Address: 1718 S 288TH ST
Project: JACOBSON LLC B FEDERAL WAY, WA 98003-3260
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) 0 Rough Plumbing(4230) 0 Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By Date
• By Date
0 Final-Plumbing(4075)
Approved
1311-: DateY.-
Ej Rough Electrical Final Electrical Right of Way
Approved Approved
Approved
By Date 1 1 By Date By Date
•
CITY OF Pyr` PERMIT iPPLI N
Federal Way ��
/� 1 7� FEB 14 2014 o`
PERMIT NUMBER 1`1 _ D 0 71 a _ l' L_ CITY OF FEDERAL WAY
—
TARGET DATE CDS
SITE ADDRESS SUITE/UNIT# J
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ a��= 70O4- _ ( a7
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT -6af-A/ D4'6 .4I
PROJECT DESCRIPTION / 7,9
ALL J, cl'
Detailed description of work to d 17/ !_
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ' /I t J.) ` .�f'f
/ ypD ' e ` � E-MAIL
/7/440f
7
CITY Q�/ e STATE ZIP
-. � GPf 4'/�G�- lA , 25.E ? 1 -/3 —
MAILING ADDRESS �/�' E-MAIL
CONTRACTOR 3 -/Z7 / 3'f_��r 'CITY �� rSTATE FAX
jl'
3
7
WA STATECONTRACTOR LICENSEI #_ D EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME... LJ-11
`(%,� J/ G/�j / PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
/ PRIMARY PHONE
PROJECT CONTACT ) �A P4 0 — �3'/( - / /�i c ! .
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING D OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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 offthis application.
SIGNATURE: DATE Z7/V;
PRINT NAME: .6-4?•49G,
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
41111
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
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.
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
VALUE OF PLUMBING WORK
PLUMBING PERMIT
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) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS IL/�E3z4
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
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
RESIDENTIAL - NEW OR ADDITION
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 Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
AreaConstruction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application