12-101856° City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: GARDNER
Project Address: 30052 6TH AVE SW
Project Description: Replace bathtub with shower.
i P Plumbing
Permit #: 12 -101856 -00 -PL
Inspection Request Line: (253) 8353050
Parcel Number: 039600 0160
Owner
A2nlicant
Contractor
LEON R GARDNER
RICK KATANA
OWNER IS CONTRACTOR
WENDY S GARDNER
HMMS
30052 6TH AVE SW
11523 17TH AVE E
FEDERAL WAY WA 98023-3520
TACOMA W 98445
Plumbing fixtures
Showers .......................................... 1
PERMIT EXPIRES Tuesday, October 23, 2012
Permit Issued on Thursday, April 26, 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
Z)�and the City of Federal Way.
Owner or agent: Date: �' - 2 6 f %�
�;D a
ropmAL/rs/Is
THIS CARD IS TOMAIN ON-SITE
C,nOF Construction In ection Record'.
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 12 -101856 -00 -PL Address: 30052 6TH AVE SW
Project: LEON R GARDNER FEDERAL WAY, WA 98023-3520
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.
Final - Plumbing (4075)
Approved
By Date
Plumbing Groundwork (4190)
Rough Plumbing (4230)11
Final Electrical
Approved
Gas Piping (4125)
1:1Approved
Approved to cover
By
Approved
Approved to release test
By
Date
By
Date
By
Date
Final - Plumbing (4075)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
CITY OF 'A
Federal Way
COMMUNITY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
L, �3;, -
PERMIT •MF
APPLICATREEjVED
APR 2 6 2012
-� 0
CO ME PL DE EN FP
SITE ADDRESS , l A l
` `~ c ``° CITY OF FEDERAL WAY
SUITE/UNIT X
PROJECT VALUATION
ZONING
ASSESSORS TAX/PCA�RCEK!
d_-
/,
TYPE OF PERMIT
❑ BUILDING jik, PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
J
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME ,. PRIMARY PHONE
cC L�. l ' ' c 4 [ ✓i C ° -' (�,I W
MAILING ADDRESS ,j-. {
` 1
E-MAIL
CITY STATE ZIP _
/� }%
(( [
NAME
PHONE
MAILING ADDRESS
CITY 1- .�'c E. r� r.. --r..
STATE
ZIP.- 150-r3
FAX
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY STATE I ZIP
FAX
PROJECT CONTACT
(The individual to receive and
NAME
PHONE
MAILING ADDRESS
, 3 4-� C-
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIPS
/
FAX
ALTERNATE CONTACT NAME: PHONE
7
�/-
E -MAD,
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 apart of this application.
SIGNATURE: }LL DATE N' d 6- /1
PRINT NAME:
Bulletin #100 -January 1, 2011 Pagel of 3 k:\Handouts\Permit Application