11-104503. `Plumbing
City of Federal Way
Community & Econ. Dev. Services Permit #: 11 -104503-00-PL
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line:
Ph: (253) 835-2607 Fax: (253) 835-2609 p q (253) 835-3050
Project Name: CIRCLE K/UNION 76 STATION
Project Address: 33520 21ST AVE SW Parcel Number: 132103 9098
Project Description: Water piping for installation of purified water vending machine.
Owner
Applicant
Contractor
PACIFIC CONVENIENCE & FUELS
SALZETTI & SONS CONTR LLC
SALZETTI & SONS CONTR LLC
2603 CAMINO RAMON SUITE 350
414 TON A WAN DA AVE NE
SALZESC947DA (3/1/12)
SAN RAMON CA 94583
BROWNS POINT WA 98422
414 TON A WAN DA AVE NE
BROWNS POINT WA 98422
Other Plumbing Fixtures ................ 1
PERMIT EXPIRES Monday, May 7, 2012
Permit Issued on Wednesday, November 9, 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: C Date:
Cr" OF V;N�p
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
11 -104503 -00 -PL Address: 33520 21 ST AVE SW
Project: PACIFIC CONVENIENCE & FUELS FEDERAL WAY, WA 98023-2874
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)Gas
Piping (4125)
Approved to cover
Approved
Approved to release test
By Date
By Date h� ��
By Date
E] Final - Plumbing (4075)
Approved
By Date
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
rig I�ERMIT
Federal c,
COMMUNITY DEVELOPMENT
253-835-2607• FAX 253-835-2609 0�. � A P P L I CAT I O N
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0 MF CO ME PL DE EN FP
SITE ADDRESS Ct,
SUITE/UNIT #
3 a0 1 S
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$
J 3 0'� _L 0 3_ q o
TYPE OF PERMIT
❑ BUILDING ;X PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
1�
12
PROJECT DESCRIPTION
� "-
Detailed description of work to
"Ike G' A-,' JC. %�� f /tom �/ %
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDRESS
61 S= w
E-MAIL
CITY
STATE
ZIP
NAME E
4<
PHONE
0?,53-� ,�-6S�6
MAILING ADDRESS
/ o �4) 4 )`l v� � �
E-MAIL
S91Z&_r
CONTRACTOR
F
C/. C-' Lo4•p
CITY�_
rbttl ,S j°QtN�
STATE
W14
ZIP
13-fi
FAX
3
^
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
1
NAME
l� J lit( &
PHONE
APPLICANT
MAKING ADDRESS
5,9""'e-,
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PHONE _
(The individual to receive and'
,
MAILING ADDRESS
40�
E-MAIL
respond to all correspondence
concerning this application)
/ti UE
CITY
STATE
ZIP
FAXFAX
(ICJ
t �
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 the city as a part of this application.
SIGNATURE: ^ DATE s//— .7— d-,;,/ a
/� .,/
y c
PRINT NAME: v OC! 1
Bulletin #100 —January 1, 2011 Pagel of 3 k:\Handouts\Permit Application
Tic.N
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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.
M EQIIANK,�FIXTURES
VALUE OFMECHAMCAL WORK
(a copy of bid or estimate must be provided)
Indicate how many of each type of fixtur , o be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
PANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIR E INSERTS HOODS (Commercial)
BOILERS
RNACES HOT WATER TANKS (cas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
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.
BATHTUBS (or Tub/Shower Combo)
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 I`TFORMATIO\' ..
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
TOTAL
FOR OFFICE USE
BASEMENT
,l
EXISTING/PREVIOUS USE
LOT SIZ Ia Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
AREA DESCRIPTION
❑ Yes ❑ No
❑ Yes ❑ No
�.. .�,, R :SII ENTI AL
- NEW OR ADDITION' ..,.
AREA DESCRIPTION (in square feet)
)�XISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
,l
ConstruTypction
FIRST FLOOR (or Mobile Horne)
AREA DESCRIPTION
Occupancy G up(s)
SECOND FLOOR
Additional Information
i uare Feet
COVERED ENTRY
Stores
i
DECK
NEW BUILDING
GARAGE ❑ CARPORT ❑
¢ "
OTHER (describe)
Area Totals
EXISTING %
PROPOSED
TOTAL
–---._.....—_.... _..... _ ..-...--- —
**NEW HOMES O \
ESTIMATED SELLING PRICE $
# OF BEDROOMS
Bulletin #100—January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
COti MERCIA:L'INE'4 ADDITION
Acrea
ConstruTypction
AREA DESCRIPTION
Occupancy G up(s)
Additional Information
i uare Feet
Stores
NEW BUILDING
¢ "
ADDITION
COMMERCIAL — RE -MODEL . NA T INIPROVEMENTS
AREA DESCRIPTION
Area Occupancy Grouli(s)
Construction
#
Additional Information
In Square Feet
a
ri
Stories
TOTAL BUILDING
TENANT ARBA ONLY
I
PROJECT AREA ONLYvwl
Bulletin #100—January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application