15-104660PIP]Pb g
City of Federal Way
Community & Econ. Dev. Services°
33325 8th Ave S €.i Permit #: 15 -104660 -00 -PL
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection Request Line: (253) 835-3050
Project Name: ORMSBY
Project Address: 1104 SW 296TH ST Parcel Number: 119600 4775
Project Description: Replace water and drain piping; extend as needed for future remodel, abandon in place no
longer utilized piping.
.Owner
ARRlican
LYNN ORMSBY
ROBERT D ORMSBY
OWNE S CTOR
ROBERT D ORMSBY •
1104 SW 296TH AVE S
1104 SW 296TH AVE S
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Plumbing -Fixtures
Other Plumbing Fixtures ............... 1
PERMIT EXPIRES Saturday,
Permit Issued on Monday, SOpi
I hereby certify that the above information is correct and
the occupancy and the yW will be in accordance with tt
Owner or agent:
�D
.c
4�jhQ v -,r
re 2016
4,201
ructionabove described property and
fes andre lations of the State of Washington
4
Way.
Date:
W
CITY or'
Federal.Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -104660 -00 -PL Address: 1104 SW 296TH ST
Project: LYNN ORMSBY FEDERAL WAY, WA 98023-8254
Scheduled inspections may be failed if this card is not on-site. DO NOT ROSE 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
1:1Rough
Plumbing Groundwork (4190)
Approved
Rough Plumbing (4230)
Final Electrical
Gas Piping (4125)
to cover
Right of Way
Approved
Approved to release test
By
Date
By
Date
By
Date
Final - Plumbing (4075)
Approved
By Date
1:1Rough
Electrical
Approved1:1
Final Electrical
Right of Way
Approved
Approved
By
Date
By
Date
By
Date
CITY OF A�
Federal Way
�ECEIVED
SEP 142015
CITY OF FEDERAL WAY
CDS
PERM I'14APPLICATION
PERMIT NUMBER /� _f 0— �—/ 6 6— O _ P- L TARGET DATE
SITE ADDRESS
I k 0 4 S t,4j -7-9 ST T
SUITE/UNIT #
PROJECTTVVALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
�o f
— — — —
TYPE OF PERMIT
❑ BUILDING 5K PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
7s R-FADL&E--
L
be included on this permit only
IAQ�A&qgt-0 MV
PROPERTY OWNER
N
RIMARY PHONE
MAILING ADDRESS ^Yl
E-MAIL
CI �
3TTE
l,•!�/
ZIP— a �
L
A4,S..K n---i�
NAME
PHONE
MAILING ADDRESS j
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME .. 11
1�
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
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 suc m arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information suppli tot city as apart of this application.
SIGNATURE: DATE qllf /I
PRINT NAME: ~
Bulletin #100 — January 1, 2013 Pagel of 3 k:\Handouts\Permit Application
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYORSEWER
PIIRVEYO
VALUE OF EXISTING IMPROVEMENTS
TOTAL
FOR OFFICE USE
............... --.....__..... ......_._......... -................... -._—
�,
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTIN IRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes o No
-
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING
4ROPOSED
TOTAL
FOR OFFICE USE
............... --.....__..... ......_._......... -................... -._—
�,
FIRST FLOOR (or Mobile Home)
SECONDFLOOR
COVERED ENTRY
OvO%f,'
GARAGE ❑ CARPORT ❑
OTHER (describe}%` „
WaSTWO
Area Totals
PROPOSED
TOTAL
-IMW HOMES: UNLY"� Fx
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL — N/ADDITION
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
a
Stories
-NEwBvz=G
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
a
Stories
r
TMAL BUMDINci
F;
TENANT AREA ONLY
PROJECT f7tAILY
r f
F
Bulletin #100 — January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application