10-101824Piu ming
City of Federal Way •
Community Development Services -
P.o. Box 9716 Permit #:10-101824-00 PL
Federal Way, WA 98063-9718 nes
Inspection Request Line: 25
Ph: (253) 835-2607 Fax: (253) 835-2609 p q 3) 835-3050
Project Name: JERSEY'S SPORTS BAR & GRILL
Project Address: 35509 21ST AVE SW
Parcel Number: 252103 9002
Project Description: Cut concrete to tie into and trench for groundwork for (2) bathrooms, kitchen and bar
Owner
Applicant
Contractor
DAVID HOEK
DAVID HOEK
DAVID'S FEDERAL WAY LLC
DAVID'S FEDERAL WAY LLC
DAVID'S FEDERAL WAY LLC
PO BOX 8164
PO BOX 8164
PO BOX 8164
TACOMA WA 98418
TACOMA WA 98418
TACOMA WA 98418
Drains ............................................. 5 Lavatories....................................... 7 Other Plumbing Fixtures..,.............. 1
Sinks ............................................... 3 Urinals............................................ 2 Water Closets................................. 3
Water Heaters ................................. 1
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Sunday, October 31, 2010
Permit Issued on Tuesday, May 4, 2010
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 W y.
/r
Owner or agent: G �C1� S �� Date: S — 11 — f6
LL �
CITY OF
Federal Way
PERMIT #:
Owner:
10 -101824 -00 -PL
DAVID HOEK
THIS CARD IS TO UPAIN ON-SITE
Construction Insection Record
INSPECTION REQUE TS: (253) 835-3050
Address: 35509 21 ST AVE SW
FEDERAL WAY, WA
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)El
Gas Piping (4125)
Approved to cover
Approved
Approved to release test
By, � Date. ze:loBy
Date la
By Date
Final - Plumbing (4075)
Approved /
By Date Z C�14--114 /
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
Federal We
CO..WUVITV DEVELOPMENT SERVICES
253-835-2607• FAX 25.3-8.35-2609
n•u;c:;iu,c;Icr1^ra.u•_:,{. r:crr
,9PERMIT O ME PL DE EN FP
OPEAPPLICATIO:LIT"'"
MAY 4;
Y
SITE ADDRESS i� -
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
'9 / �
(� G r� " ` S V y f ! r !
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
11�1�
e i) e 5 �� G n
)j
r 6v-,,, ,.! ff C �l► S �� t « .�
41
PROPERTY OWNER
NAME PRnsARY P
MAILING ADDRESS`o i3 ul `x%17
E-NfAIL
CITY -,-e STA'�E ZIP
J TL /
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EI9PIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
-
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
-
CITY STATE [ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all Correspondence
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
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 th ty as apart this application.
SIGNATURE: C/" L L C DATE S-- 7 -
PRINT NAME: (ll %J /� , /ye a
Bulletin #100 - April 14, 2010 Page 1 of 3 kA-landoutsTermit Application
0
VALVE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
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 (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of furture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or7Lb/shower combo) �I
LAVS (xeudSmks)
�l
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
oZ
URINALS
( OTHER (Describe)
_ DRAINS
SHOWERS
VACUUM BREAKERS
kdU� C A
DRINKING FOUNTAINS �_
SINKS (Kitchen/utility)
_�
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINESii%i<C`L`i?i`>`
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?
❑ Yes ❑ No ❑ Yes ❑ No
AREA DESCRIPTIONI in SquareArea
Feet Occupancy Groups)
ADDITION
AREA DESCRIPTIONI in Square Area
Feet Occupancy Group(s)
TENANT AREA ONLY
ConstructionI # of I Additional Information
Tvne Stories
ConstructionI # of I Additional Information
Tvue Stories
Bulletin #100 - April 14, 2010 Page 2 of 3 k:\Handouts\Permit Application