02-101244City of Federal Way
Conununity Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: ST FRANCIS HOSPITAL
Project Address: 34515 9TH S
Plumbing Permit #:02 -101244 - 00 - PL
Inspection request line: 253.835.3050
Parcel Number: 750451 0020
Project Description: PLUMBING - Install (1) dishwasher, Move handsink and install (3) reduced backflow prevention devices
for dishwasher and hose reel. Work is located on ground floor, kitchen by loading dock.
Owner
Applicant
Contractor
ST FRANCIS MEDICAL
PLUMBING JOINT, THE
PLUMBING JOINT, THE
1717 S J ST
351 UNION AVE NE
351 UNION AVE NE
TACOMA WA
RENTON WA 98055-4194
RENTON WA 98055-4194
98405-4933
(425) 228-3204
Plumbing Fixtures
�nDecripticn, "',.ft:scr tion # C anti !?escriptdn„ fid''' Quanlaty
Dishwashers 1 Rain Water Systems 3 1 Sinks L
PERMIT EXPIRES September 18, 2002, IF NO WORK IS STARTED.
Permit issued on March 22, 2002
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:
'0104wi "
' k 'T/'P�a'o '5's
X11
Date: ��✓yc�
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING 99 PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descri do ): CA mhGt Q
L P S
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
alhl Ffanci3 /
Qr . MJVF- �.qn,i Sl 1►�LS I
04-( o e arc
NAME:I DAYTIME PHONE
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, P):
A ve 5 FeAral Vit, . M0
NAME: � / C'. 1 ' h U W
DAYTME PHONE:
(� g
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
351 Uhioh Ave Nt. Re> on �'✓�
9gD57
EVENING PHONE:
( ) 5A PIE
CITY OF FEDERAL WAY BUSINESS LICENSE
�
NUMBER:
� - o o
Q - L
FAX NUMBER:
-3�5
CONTRACTORS REGISTRATION NUM
(copy of card �W�)
P 7 9
EXPIRATION DATE:
09 / 2 i
/�
APPLICANT: NAME:64DAYTIME PHONE
MAILING
EVENING
AD(STREET
! A _e ATEIPC4�1�`1 ���1. �W ( �) PHONE:
RELATIONSHIP TO PROJECT. FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): (�9 ) ;?y
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
yyyyO�
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ AC/��l/l�
-
SPRINKLERED BUILDING? ❑ YES ® NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) 4
SEWER SERVICE PROVIDER: 11 LAKEHAVEN ❑ HIGHLINE 11 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** "
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
t
■ PRO]EPT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
�_ LAVATORY(S)
URINAL(S)
WATER HEATER(S)
FIRST
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
SECOND
SHOWER(S)
SINKS)
WASH MACHINE OUTLET
WATER CLOSETS)_
MISC.
THIRD
SUMP(S)
2n•ig�
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACE INSERT(S) RANGE(S) MISC. ( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of
Federal Way, 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.
NAME/TITLE: "' � C' Vil !1 y GATE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-6661-4000 - FAX: 253-6661-4129
PLUMBING
BATHTUB(S)
�_ LAVATORY(S)
URINAL(S)
WATER HEATER(S)
I DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
SHOWER(S)
SINKS)
WASH MACHINE OUTLET
WATER CLOSETS)_
MISC.
INTERCEPTORS)
SUMP(S)
2n•ig�
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
further, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of
Federal Way, 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.
NAME/TITLE: "' � C' Vil !1 y GATE:
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-6661-4000 - FAX: 253-6661-4129