12-100303City 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: VALLEY HARVEST
Project Address: 28855 MILITARY RD S
Project Description: Install mop sink.
Plumbing
3�,
Per it #: 12-100303--40-PL
Inspection Request Line: (253) 835-3050
Parcel Number: 042104 9037
Owner
Applicant
Contractor
KEVIN ERICKSON
A -LIST PLUMBING & HEATING LLC
A -LIST PLUMBING & HEATING LLC
VALLEY HARVEST INTERNATIONAL
21133 22ND AVE SW
LISTPPH893CM (2/14/13)
MARKET
LYNNWOOD WA 98036
21133 22ND AVE SW
28855 MILITARY RD S
LYNNWOOD WA 98036
FEDERAL WAY WA 98003
Sinks............................................... 1
PERMIT EXPIRES Sunday, July 22, 2012
Permit Issued on Tuesday, January 24, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and thew will be in accord ncp with the laws, rules and regulations of the State of Washington.
an t e City of Federal Way.
Owner or agent: Date:
FINAUeb c/rs112�
CITY OF
Federal Way
PERMIT #:
Project:
is
THIS CARD IS TO MAIN ON-SITE
Construction I ection Record
INSPECTION REQUE TS: (253) 835-3050
12 -100303 -00 -PL Address: 28855 MILITARY RD S
KEVIN ERICKSON FEDERAL WAY, WA 98003-7912`
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 a 23
❑
Plumbing Groundwork (4190)
Rough Plumbing (4230)
Final Electrical
Approved
Gas Piping (4125)
Approved to cover
By
Approved
Approved to release test
By
Date
By
Date ��l„ 1 Z_
By
Date
Final - Plumbing (4075)
Approved
By Date a 23
❑
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
fur�.
CITY OF r.,.
JAN _.� PERMIT
Federal Way 4 r u'
COMMUNITY DEVELOPMENT SERVICES WICATION
253-835-2607• FAX 253-835-2609 FE
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6 MF CO ME (E)DE
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SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAIL/PARCEL #
TYPE OF PERMIT
❑ BUILDING PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
/
(Tenant Name/Homeowner Last Name)
V
PROJECT DESCRIPTION
Detailed description of work to
12
be included on this permit only
PROPERTY OWNER'
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
---.—�
CITY STATE
ZIP
NAMEPHONE
G/�5T �LusN �i�i�i "r-i1F•/rN GCG
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MAILING ADDRESS
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E-MAIL
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CONTRACTORZ/i
CITY
G �n 6voo 7
STATE
141 +
ZIP
9�P.7/.
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
boa- 072.- do i2 i 3/ i /Z -
NAME
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME -t'
HONE
- S- Y6 8,- a
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
STATE ZIP
FAX
ALTERNATE CONTACT NAME: PHONE
PROJECT FINANCINGfMZA1LIN1:AD�D1F-S1.
0 OWNER -FINANCED
Required value of $5,000 or mor
CITY, STATE, ZIP
PH
(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 authorised 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 o such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim es out of the r Ii ce of the city, including its officers and employees, upon the accuracy of the
information supplied to the cias apart ofs lication.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 —January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
CGS
VALUE OF MECHANICAL WORK $
BATHTUBS (or Tub/shower combo)
(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
FIREPL INSERTS
HOODS (commercial)
BOILERS
F ACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
WATER HEATERS (Eleetri�)
HOSE BIBBS
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
T
DRINKING FOUNTAINS
1 SINKS )Kitchen/utnity)
WATER HEATERS (Eleetri�)
HOSE BIBBS
SUMPS
WASHING MACHINES
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
Bulletin #100— January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application