15-103212 - rPh nbing
' tof FederalWay
Communiy&Econ.Dev.Services Permit #: 15-103212-00-PL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 8 5-3050
Project Name: JACOBSON,BRETT H DDS
Project Address: 1718 S 288TH ST Parcel Number: 332204 9109
Project Description: Adding 2 sinks and relocating 2 compressed air outlets.
Owner Applicant Contractor
JACOBSON LLC B JEFF HEAD HEAD MECHANICAL INC
1718 S 288TH ST HEAD MECHANICAL HEADMMI912O3 (9/23/15)
FEDERAL WAY WA 801 E 1ST ST STE#:8 801 E 1ST ST SUITE 166
98003 CLE ELUM WA 98922-1246 CLE ELEUM WA 98922
Plumbing Fixtures
Other Plumbing Fixtures. 2 Sinks 2
PERMIT EXPIRES Tuesday, December 29, 2015
Permit Issued on Thursday, July 2, 2015
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 agent: s. cUr Date:
-z4 , ,_
IN
ALIC°
DATE -1 INSPECTOR AREA AND TYPE OF ISPECTION
_t g,(iC 1)40'4l 12"0"114— u - r t, ,. ICC.? i3rrua(04/v Y.G.�-
• THIS CARD IS T MAIN ON-SITE
CITY OF Federal WayConstruction Inspection Record
INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-103212-00-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.
o Plumbing Groundwork(4190) 0 Rough Plumbing(4230) GI Gas Piping(4125)
Approved to cover Approved Approved to release test
'By Date 'By 444L, Date -,1 10 ji
5- 'By Date
o Final-Plumbing(4075)
Approved
By 10- Date 1 (2l 11$
Rough Electrical CI Final Electrical 111 Right of Way
Approved Approved Approved
By Date By Date By Date
• RecervED •
[rioF JUL 02 2015 PERMIT APPLICATION
IFederal Way CM'OF FEDERAL WAY
CDS
— i /d
PERMIT NUMBER I l b 13 - j I
TARGET DATE ` 1— k
SITE ADDRESS SUITE/UNIT#
7 13 2-CS 5-�
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
ti
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
r
NAME OF PROJECT
PROJECT DESCRIPTION / A DO _5• •• ��AJ r ✓�c M v Ai , It&, ' P/,/,41 Ii i
Detailed description of work to 8 Cs'h c`r Z S ^� S
be included on this permit only
NAME � ( _ ....._ PRIMARYPHONE+
PROPERTY OWNER �' �\c -c (Lot- cv.'--) Zb(0-730 < j
MAILING ADDRESS/`� E-MAIL
CI.{,11 1 V 9 -43g°-57.>
l /
rA
NAME f y
�'2 y
cA
MAILING ADDRESSE-MAIL
CONTRACTOR 2-0 F`/1'15T?e ��I C4
[
'(--0'
Cry
�� � TAT ZI$7 FAX
TATE CONTRACTOR'S LICENSE#
LA7WnTCI\ 77EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /5 / s; tv Z-)`v"Lx-)
�� MARY jPHONE
CP
^'�
NAM 4�/�i ACin V CSG. 1 N V (AA LA- (P l 1
APPLICANT MAI ING ADDRESS
kke
f 8T TE ZIP
NAME 1PRIMARV PHONE
PROJECT CONTACT (5�-� )G'
MAILING ADD MAIL
The individual to receive and , r
respond to all correspondence ` E • 1 F� " �� Veark 1-A42_kker- C°'"
concerning this application) CITYI A ^ + z). q(,
C 1 Il
V V ( c)9 _,--7T G�Q
NAME0 OWNER-FINANCED
PROJECT FINANCING _ tlr�I
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, o.. attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersign and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employ,.-:::. upon the accuracy of the
information supplied to the city as a part of this op•lication. �,
SIGNATURE: � � / DATE 7//�2�/5
PRINT N• � 7 �• _`�
Bulletin#100—January 1,2013 Page 1 of 3 •1-landouts\Permit Application
•
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(car(
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $ 3i
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(Descm.e)
DRAINS SHOWERS VACUUM BREAKERS 1 J
DRINKING FOUNTAINS 7 SINKS(Kitchen/Utility( WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIX RES
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?
L Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEIN OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
1 ,
COVERED ENTRY
a
• DECK «<
GARAGE ❑ CARPORT ❑
ter,
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— ENIODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of 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:kHandouts\Permit Application