08-101333 As _
• Plumbing Permit 08-101 X33-0( -PL
r:rnrn : ices •
P.O.Bqx 9718
Feder Way,WA 98063-9718
Ph (253)835-2607 Fax:(253)835 2609 Inspection Request Line: (253) 835-3050
Project Name: FRED MEYER PHARMACY TRAILER
Project Address: 33702 21ST AVE SW Parcel Number: 930100 0010
Project Description: Hook up waste and water to temporary trailer ;, ,
,
Owner Applicant Contractor
FRED MEYER INC. GULF STATES PLBG&MECH INC GULF STATES PLBG&MECH INC
PO BOX 42121 1707 TAYLOR ST GULFSSP931BK 1/12/09
PORTLAND OR 97242 CENTRALIA WA 98531 1707 TAYLOR ST
CENTRALIA WA 98531
Plumbing Fixtures
Sinks 1 Water Closets 1 Water Heaters 1
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Saturday, March 20, 2010
•
Permit Issued on Thursday, March 20, 2008
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 t City of Federal Way.
Date: -_
Owner or agent: )1(c-- �Z-L7�—�7
THIS CARD IS TO MAIN ON-SITE
CITY OF �k ommunity Develop t Inspection Stecord
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-101333-00-PL
Owner: FRED MEYER INC.
Address: 33702 21ST AVE SW
FEDERAL WAY, WA 98023-7762
This card is part of your required inspection documents. Scheduled inspections maybe 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.
O Plumbing Groundwork(4190) ❑ Rough Plumbing(4230) 0 Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date . By.. CN....) Date 3-27,0 By Date
O Final-Plumbing(4075)
Approved
By Gam, Date -27 M d e.
•
•
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
AV
Clic N p I. Y J_ 33.3
Fe eral Way RESUB •COMWNSERVICES M 'E�E R MIT
T SF MF CO ME MODE E EN FP
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3-BO1X8970978
MAp 2O
APPLICATION
IrD / /
253-835-2607.FAX 253135-269
wunAtilifofkderdwawceITY OF FEDERAL
eevv
The following is requlrew rRhEomplete application will not be accepted. Please print legibly(in ink)or type.
'-'��'i • PROPERTY INFORMATION
SITE ADDRESS ,33-7 12Z --1 SI Au C S Li SUITE/UNIT 9
ASSESSOR'S TAX/PARCEL 9 - _ __ LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
enacts+ip•rate roe for kn w ivai dedwpe�Y
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 96-.PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
{—n O IZ- u P w\es- 14-vi 1 , ‘,..›vr-Ql --/b �-e .ip if-n/ kitr14 cel -I-r' i!e,/
PROJECT NAME(Name of Business or Owner Last Name) Fre ci )4 vei- ,Agyi c Ir
• PEOPLE INFORMATION
PROPERTYPRIMARY PHONE
OWNER Irt-t . 1AK-evey5 ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
POI5v/ %2(21 Pewie- _b3 - 722 2-
CONTRACTORP E APPLICANT NAME OFFICE PHONE
CU .S7*7� PCVOi Gr p/ (3(0t')33 0 -7777
MAILING ADDRESS STATE+ZIP CELL PHONE
767 -11-V4-37 (Y6tif 4 1,4 7�7,Z3/ ( ) -
CITY OF FEDERABUSINESS UCENSE NUMBER TION DA FAX NUMBER
( ) -
CO N'/REGISTRATION OSS EXPIRATION DATE f-MAIL ADDRESS
(J-u/-E 55P 7313X- /-/2..,07
APPLICANT NS7�r pc_ ���AMEAPP CANT NAMEFJ lO`OFFFIICCE PHONE
44
MAILING ADDRESS
CITY,STATE,ZIP��L�f CELL PHONE St) -. 7-7-
/7b7 774-I ..�-- ST G-&-- 1-ya/1-4, t-X14--C2W ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
a Architect a Tenant a Agent a Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( ) -
LENDER NAME Per RCW 19.17.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) _
■ DETAILED BUILDING INFORMATION l
EXISTING USE PROPOSED USE r
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? a YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES a NO
WATER SERVICE;PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS XTZSTUIO PROPOS= TOTAL rora=WOW IT TOTAL MPG=ST TOTAL Jr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITHAPPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commoeioq
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/shover combo) LAVS(swum:stoke URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS ) WATER CLOSETS(rosrq
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
•
SIGNATURE
I certify under penalty of perjury that I am the property owner or authorised'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 complicates 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 dolens,of such claim), which may be made by any person, including the undersigned, and filed
where such claim arises out • fiance ofthe city,includingits officers andagainst the city, but onlyt
of ,pl employees, upon the accuracy of the information supplied to
the city as a of this applicati
SIGNATURE'. DATE 3—Zo
• , Owner and/or Authorized Agent
a NEW o ADDITION o ALTERATION o REPAIR a,TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a.YES o NO
r ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application