11-104919City of Federal Way ? _,
Community & Econ. Dev. Services s
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: DR. JACKA, DDS
Project Address: 700 S 320TH ST Suite E
Project Description: Installling a new clothes washer.
Plumbing
Permit #: 11 -104919 -00 -PL
Inspection Request Line: (253) 835-3050
Parcel Number: 082104 9265
Owner
Applicant
Contractor
CAPITOL SQUARE LLC
SUNRISE PLUMBING LLC
SUNRISE PLUMBING LLC
PO BOX 18194
1415 22ND ST NW
SUNRIPL924M8 (7/28/12)
SEATTLE, WA 98118-0194
AUBURN WA 98001
1415 22ND ST NW
AUBURN WA 98001
Laundry Washer Outlets ................. 1
PERMIT EXPIRES Sunday, June 10, 2012
Permit Issued on Tuesday, December 13, 2011
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: '� `�/�'�"J Date:
CITY 4F
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction'lection Record
INSPECTION REQUE TS: (253) 835-3050
11 -104919 -00 -PL Address: 700 S 320TH ST Suite E
CAPITOL SQUARE LLC FEDERAL WAY, WA 98003 4* -
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.
❑ Plumbing Groundwork (4190)
❑ Rough Plumbing (4230)Final
- Plumbing (4075)
Approved to cover
Approved
Approved
By Date
By Date�z ��� ��
B Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY Of <-e'
Federal Way
COMMUNITY DEI ELOPLIENT SERFICES
253-835-2607- FAX 253-835-2609
OPERMIT FISEf I01F
APPLICAR`ty'
CLEC � 3 'ZL�:II
-1�L�T
CO ME PL E EN FP
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SITE ADDRESS
civOFF DERA
SUITE/UNIT #
Dr -ROW4.7 z.-cka
PP5S
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ go C)
— —
—
TYPE OF PERMIT
❑ BUILDING PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
De Thep w4av Tac_kz- OD5
PROJECT DESCRIPTION
Z. -fee hew C��y e.,
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME �+
tva %Al
PRIMARY PHONE
MAILING ADDRESS
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E-MAIL
CITY
.'ecOM_
STATE
lam,
ZIP
NAME
ftccsr/S 7'/k�,c6r'K �-LG
PHONE
2�3�8�y�yd�3
MAILING ADDRESS
/y .2 d 57 -NW
E-MAIL
u/dnTl HP/Se
CONTRACTOR
CITY 61�.
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STATE
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ZIP emp t
Tp-
FAX
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WA STATE CONTRACTOR'S LICENSE #
SuN2� L.9ZyM
EXPIRATION DATE
? i2$ izerz
FEDERAL WAY BUSINESS LICENSE #
NAME
$'*Wa al Aikove-
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
NAME
S'G 1n.774O,
PHONE
MAILING ADDSS
/7 U1 J` AZ C(/ fT AIW
E-MAIL
h ri►+ rJOtsR d C�%Kwe6'
respond to all correspondence
concerning this application)
CITY
AU IAP rL
STATE
ZIP
l
FAX
2" 833_x36 �
ALTERNATE CONTACT NAME:
c�vdc� we,T
PHONE
Z ffl
E-MAIL
est fuwr19- P/-^�rM i
PROJECT FINANCING
NAME
❑ 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'oIf t�hiisapplication.
SIGNATURE:
^_'' DATE
PRINT NAME:
.4"-
Bulletin #100—January 1, 2011 Page 1 of 3 k:AHandouts\Permit Application
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