09-104592 P1u nbing
City of Federal Way Q
Community Development Services Permit #: 09-104592-00-PL
P.O.Box 9718F I LE
Federal Way,WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 P q
Project Name: LIFECARE CENTER
Project Address: 1045 S 308TH ST Parcel Number: 082104 9042
Project Description: Install drains,vents & water piping for(1) floor& (1) handsink.
Owner Applicant Contractor
FEDERAL WAY CONVALESCENT CENTER J&K PLUMBING INC J&K PLUMBING INC
PO BOX 723548 34127 183RD AVE SE JKPLUI*I59RD(3/19/11)
ATLANTA GA 31139-0548 AUBURN WA 98092 34127 183RD AVE SE
AUBURN WA 98092
Plumbing Fixtures
Drains 1 Lavatories 1
PERMIT EXPIRES Saturday, May 22, 2010
Permit Issued on Monday, November 23, 2009
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 Ci of Federal Way.
Owner or agent: 447-75 Date: //0-:37c,"?
THIS CARD IS TO REMAIN ON-SITE .
CITY Of � `�'`u Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 09-104592-00-PL Address: 1045 S 308TH ST
Owner: FEDERAL WAY CONVALESCENT ( FEDERAL WAY, WA 98003-4706
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) El Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By /9/4.- Date HABy Date
❑ Final-Plumbing(4075)
Approved
By Date
•
n Rough ElectricalEl Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
Federal
E�.VEERMITT
SF CO ME ELPL DE EN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION ( / /
253-835-2607•FAX 253-835-2RO V 2 L
www.cituoffederatwa u.corn
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PROP fi � mo y , DI. 4 4�
frn - E aar ;h ;! i 5*^S 1 a.a his y .� ja -s� „�' ,p4',SITE ADDRESS
SUITE/UNIT# ZONING ASSESSOR'S TAR/PARCEL#
o g z / a4- C? O 2 -
A.. ' �f5"- 5 '`
NAME OF PROJECT
(Tenant or Homeowner Name) 4-1%ezd.fj ' CC/%/722
❑ BUILDING XI PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
//1/ 7; 4-1-- D.411,//Lf / �C Iv'--•• CI-97 7' fi,�!�2
PROJECT DESCRIPTION rQ /—f'G17 d4 7�k 1 f— 1-7,-,7 AI J A ,
Detailed description of work to ! /-
be included on this permit only �e..{,c?N( t-I -GG,�yS� '5,rjI/-< , h,,N" ,4/f-c
PEOPLE 4444-:'14''' .
�,, ;WOO 0
NAME (0- )-- (---/PRIMARY PHONE
PROPERTY OWNER L/1.—C C'_/-}A� <°/_(�l 7-1 ^ -/4e/
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: ❑ CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
ow- fi-41t7 LC7I Nr- - riii - , ( -/----
c: CONTRACTOR MAILING ADDRESS CITY STATE, P ` 4� / /0/, FAX
3 / z7 /Y3 V : . 7?, -A9?
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAMEPRIMARY PHONE
APPLICANT e� k / _.e.172767711//d- 4 ( ) -
MAILING ADDRESS,CITY,STATE,ZIP FAR
(
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( ) -
ALTERNATE CONTACT NAME: ,PRIMARY PHONE E-MAIL
( /
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27095) ( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this applicati
SIGNATURE:\-2�i�GGt ( ,e1-4_,---/ DATE /7/Z 3/.,=:9Y.
PRINT NAME: L`�C���� I L— 2 Ar G"' 7r Z-L�� `W- c:35-:/74 /4-
Bulletin
/5-:/ /4-Bulletin#100-4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
-411
MECHANICAL FIXTURE
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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(Ons)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate number 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 LAVS(Hand Sinks( TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility( WATER HEATERS(Electric(
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Q%y
$ A( L-r4k 7-f-4lM ?) $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESI.DENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY ,_-----...........----..._------------ ---------
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
=STENO PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL- NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application