12-100857Plumbing
City of Federal Way Permit #. 12 -100857 -00 -PL
Community &Econ. Dev. Services
333 W 8th Ave S FILE
Federal Way, WA 98003 Inspection Request Line: (253) 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: LEACH
Project Address: 29812 5TH AVE SW Parcel Number: 062104 9124
Project Description: Electric water heater changeout
Owner
Agnlicant
Contractor
DENNIS LEACH
SUSAN C LEACH
WASHINGTON ENERGY SERVICES CO
SUSAN C LEACH
29812 5TH AVE SW
(GENERAL)
29812 5TH AVE SW
FEDERAL WAY WA 98023
WASHIES9710B (9/2/13)
FEDERAL WAY WA 98023
2800 THORNDYKE AVE W
SEATTLE WA 98199
Plumbing Fixtures
Water Heaters ................................. 1
PERMIT EXPIRES Tuesday, August 21, 2012
Permit Issued on Thursday, February 23, 2012
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: {' Date:
rmaxt> ;/L/12
f • ' THIS CARD IS Tole MAIN ON-SITE
CITY. VA�' Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #:
Project:
12 -100857 -00 -PL
DENNIS LEACH
Address: 29812 5TH AVE SW
FEDERAL WAY, WA 98023-3516
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)
E]Right
Approved to cover
By
Approved
Approved
By
Date
By
Date
By
Date g—d2_- !.Z
❑
Rough Electrical
Approved
Final Electrical
Approved
E]Right
of Way
Approved
By
Date
By
Date
By
Date
W7
CITY OF
Federal Way ECERMIT
COMMUNITY DEVELOPMENT SERVICES A L I C A T I O N
253-835-2607• FAX 253-835-2609
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a-2re (-
MF COME PL DE EN FP
SITE ADDRESS
SUITE/UNIT M
PROJECT
ZONING
ASSESSOR'S TAX/PARCEL
[6V�ALUATION
Od
—
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
enant Name/Homeowner Last Name)
/
Ac J E�
L � E7
PROJECT DESCRIPTION
etailed description of work to
�p _ / �2� 7
4 S
be included on this permit only
PROPERTY OWNER
NAMEc / /
I,� 'I t'7 !S
PRIMARY PHONE
MAILING ADDRESS�.�fL
E-MAIL -
CITY
STATE
11/01,
ZIP
d z 3
-
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE N
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE 0
NAME G.Vy,.� Q. S
'
PHONE
MAILING #DRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
NAME
u � Gt 5 Yv , ��✓ QG.��J
PHONE
MAILING ADDRESS
E-MAIL
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5, 000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 suchc 'ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
t
information supplied y as a part s appllica�tioonn.
7 2
SIGNATURE: �� �%'t/��-j---- DATE
/
PRINT NAME:
Bulletin #100 – January 1, 2011
Page 1 of 3
k:\Handouts\Permit Application