08-101106 sr
City otFederal Plumbing Peri #: 08-101106-00-PL
Community Development Services
P.O Box 9718
Federal Way1 WA. 98063-9718
Ph (253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: FRED MEYER V
5.
Project Address: 33702 21ST AVE SW Parcel Number: 930100 0010
Project Description: Add and remove electric water heater, (3)sinks.(3)vacuum breakers,hub drains and floor
drains for the interior remodel of the existing Fred Meyer.
Owner Applicant - Contractor
FRED MEYER INC. GULF STATES PLBG&MECH INC GULF STATES PLUG&i)Ecii INC
PO BOX 42121 1707 TAYLOR ST GULFSSP93IBK 1/12/09
PORTLAND OR 97242 CENTRALIA WA 98531 1707 TAYLOR ST
CENTRALIA WA 98331
Plumbing Fixtures
Other Plumbing Fixtures 34 Sinks 3 .Vacuum Breakers 3
Water Heaters 1
•
PERMIT EXPIRES Thursday, March 4, 2010
Permit Issued on Tuesday, March 4, 2008
I hereby cer : j ie above intormaton is:Correct and that the construction on the above^described prcperty'and'
the occupency and;the use w be inaccordance with the taw, rules and remotions of the_SliAea sh ne; r, .,
tha.City of Federal Via
K�
`"
Owner or G����rlt: ._�6 4°6 crate:_
THIS CARD IS TO AIN ON-SITE pm
CITY OF !ommunityDevelo i t Inspection Record
�
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-101106-00-PL
Owner: FRED MEYER INC.
Address: 33702 21ST AVE SW
FEDERAL WAY, WA 98023-7762
This card is part of your required inspection documents. Seileduled 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.
It
0 Plumbing Groundwork(4190) 0 Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Datele-Z4"-dBy LA..) Date,V/_ oce By Date
[] Final-Plumbing(4075)
Approved
12y G C t Date
i
•
•
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved •
By Date By Date
6-I- 6 ...1 'fi cii ,.", \11 \\\ A=-t -4, - , t-'. s: . . k4 ;1 C1'4 )t4 tz •
- .V
a , ? � \ Z
� */
v .1 ." .
• � c � p Q - i
li. ( a �' & a k s a % ate l Q kItp► m
\-. 0 (‘ f\ r AA 'X' c r. f\ X1\ (7A 1\. 1\ I\
`9' [ t- L L \'' \\"' \'' t 'V— ff LL EvEiE ;
o
700) 0 ze .; $\ [ ., -N- ts,f-) .• -6 ° (.t -1°c?--711 I
% N * ‘ v— --i.. . Th.
. I 4-) , , r
' 4 1 I • --R `'. vl % ?
s:___ .?- 0, 6 -% ..., L r „,,j_ _ . .„..irr oR, os .. . .4 -4
E . V 3' e t - . t L -I-•
M -K- .1-,1 -v IN .Z1 € -\t 5*6 '1r Z t s CD gI r ''pi
cR— s , ,- k 4,z.,(0 ,1 -,k ;1_..74 l' . .
, Fr- (T. t
E. ,,,,,1 1 ;ct--
R ft- 4--) L . z ! A- <i !;. - __ . tr., t� F >
� ;6 t (-, ;'
�c h ®� N k �,4' p:<E`D g 1 k -----N ).. . .) , Vis. E.
t '4: f* — ‘ ?'s 6 4 k` . 1 ' sk^ tii)
3° Ci) 0 r. .70, -z\ ,vi tL)4 _t . 4itc, L q k .1& 9
1 _4
zi.... „
„1...)... L ,_... Ti .„ ,.: _ :. 11 .,
r F.,- t,, , \‹ c , ,.k ,
a 't k ' . k\ - ti `.- . ;Ix1)
ci6 \s,v1- - i7L .Z ' 1
z
E ..- t-3 'cf. ‘'ll' ---']\ k k f) - 4 .
-.:...,L r 3
u
k 0 ) r
.. ..._ i .
1
• 0 . „
Kris' Backflow Testing .
30813 8th Ave. S.W. Federal Way, Wa 98023
(253) 945-6290 (206)423-5156
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
ACCOUNT#
NAME OF PREMISE FaPll y c/Tt1/ .f Commercia Residential 0
Q ./
SERVICE ADDhr;SS 3370-1 a\.s� 4 .SUV CITY ZIP_
CONTACT PERSON PHONE( ) FFAX( )
LOCATION OF ASSEMBLY �c 7u)l/f LLA S c C/ 7netzi�iAln,�
DOWNSTREAM PROCESS 1 iQ / DCVA 0 RPB,6OPVBA 0 OTHER
NEW INSTALL 0 EXISTING ❑ PROPER INSTALLATION?YES$-NO 0 I�
MAKE OF ASSEMBLY L^JdCr MODEL ON SERIAL NO. N65.92 SIZE 1/2— "
DCVA/RPBA DCVA/RPBA RPBA PVBA/SVBA
INITIAL CHECK VALVE_119.1.1 CHECK VALVE NO AIR INLET
TEST CLOSED TIGH'(V CLOSED TIGH1 OPENED AT 3,Q
LEAKED 0 LEAKED 0 PSID OPENED
. AT PSID
PASSED PSID PSID #1 CHECK
6"t 4" PSID DID NOT OPEN 0
FAILED 0 AIR GAP OK?
CHECK VALVE
NEW HELD AT
PARTS PSID
AND LEAKED 0
REPAIRS
CLEANED 0
REPAIRED 0
TEST AFTER CLOSED TIGHT 0 CLOSED TIGHT 0
REPAIRS LEAKED 0 LEAKED 0 OPENED AT AIR INLET PSID
PSID
PASSED PSID PSID CHK VALVE
0 #1 CHECK PSID PSID
FAILED 0
AIR GAP INSPECTION:Required minimum air gap separation provided? Yes 0 No 0 Detector Meter reading
REMARKS: LINE PRESSURE PSI CONFINEDIJSPACE?S
TESTERS SIGNATURE: �� CERT.NO.b3704 DATE l —a Li"W
TESTERS NAME PRINTED: . Jolley TESTERS PHONE#(253)945-6290
REPAIRED BY: License# DATE
FINAL TEST BY: CERT.NO. DATE
So
'CALIBRATION DA GAUGE#03060161 MAKE MIDWEST MODEL 845-5
SERVICE RESTORED? YEIA NO 0
I certify that this report is accurate,and I have used WAC 246-290-490 approved test methods and test equipment.
�.� '' • a_ c - � 0 ( t Lb
raeraiv a�REC EIERMIT
COMMUM7YDEVELOPABNTSERVICES
SF MF CO ME EL�L DE EN FP
33375 S' AVBYUE SOUTH•/O BOX 9718
'253435460PPAX253J1352609 MAR 0 4 21" :P P LI C ATI O N .� �' _____.
www.cituoffederaboau.cont
The foilowinct!T qut'i°e�tWag4=ltn"{hApiete application will not be accepted. Pleaseprint legibly(in ink)or
a type.
■ PROPERTY INFORMATION
SITE ADDRESS- •76I/ 2f l V15 / SUITE/UNIT i
ASSESSOR'S TAX/PARCEL# _ _a / 0 .V - 0 o f d LOT SIZE(sj
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 7 r'(D m.e 'GY S
reach separatepog•ler description)
• PROJECT INFORMATION
)(TYPE OF PERMIT 0 BUILDING PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION
n(Provide detailed description of work included on this permit onll/)
Alf___Acit,11. /`t Iof 01/6— 1/ ,4 �z ' is o _ j 10/AZ Alp/j1
- A slLs//02 12...e'iv Ob/gem .ips-A/h 1e il— � ' /11G/t�
( r
PROJECT NAME(Name of Business or Owner Last Name) 1 l- fr 5
• PEOPLE INFORMATION l
4..FROPERTY NAME PRIMARY PHONE
OWNER .M!►I Ylen W1- / r ( ) -
LINO ADDRESS 7 CITY,STATE,ZIP E-MAIL ADDRESS
•38 6e) Zz►iD A-vE %-b •t) nit.
)(CONTRACTOR COMPANY NAME
APPLICANT NAME OFFICE PHONE
caag-D,,L-rie--rs 1)(s,..4„ (,34� ) 33b -7-7 7-7A CrrY,STATE,ZIPCEL.PHONE/707 /o/ Ze...�.-�,:s. ,� .9/s ' cam ) -s-i-sr
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATEFAX NUMBER
0$ 1.bb 2 S-0 /,2---J/- a ( ) -
CONTRACTOR'$REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
9- 0L -554393/a442-0el
APPLICANT COMPANYCO��pNN�A��MEE,, APPLICANT NAME OFFICE PHONE
14iAIIdiVOAD"DRSSS4'L` ( ) -
CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent 0 Other ( )
PROJECT N PRIMARY PHONE -MAIL ADDRESS
CONTACT eE
rr '�( eV- (Ell—)�fi S= yG s-5--
LENDER NAME Per RCW 19.27.095:
• r?T Ls t/pro eof . . ears$5,00
O AD'RESS • ,STATE,ZIP ONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PRO•• = •D USE
EXISTING ASSESSED/APPRAISED VALUE$ •ALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑YES ❑NO F i.•' - ' •PRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHA .- ' ❑ HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKE. VEN a HIGHLINE ■ • • ATE(SEPTIC)
• PROJECT FLOOR AREAS ,
AREA DESCRIPTIO EXISTING PROPOSED ., TOTAL
BASEMENT SQ.FT. SQ.FT. SQ.FT.
FIRST -
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS I ammo I • • , I tura. TOTAL '' , 'sr TOTAL norm=Al TOTAL IT
"NEW HOMES ONLY" NUMBER OF BED MS ESTIMATED S G PRICE $ _
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
„r . Cw
V.. - ,1Mec hanical Work$ (A •Pl O'BID OR ESTBIA " BE INCLUDED PLICATION)
AIR HANDLING 4 NITS EV ••RAT! COOLERS GAS PIPE 0 . ETS WOOD' •VES
BBQS F S ,AS WATE' EATERS MISC • , 'be)
BOILERS -r: •LACE INS.. OOD3
COMPRE'•ORS _ FURNACES G:•
DU GAS LOG SETS RE•' e.SYSTEMS
PLUMBING
BATHTUBS(.r Tub/Shwa.c.nb.) _i____ LAVS Maths''s=alt=s4 _ _ URINALS MISC(Describe)
_ DISHWASHERS RAINWATER SYST _ - VACUUM BREAKERS
2Ce K,e j�i2#v r.6
_ DRINKING FOUNTAINS — SHOWERS WATER CLOSETS(uses Q C6a-pad-,�
I!_ ''LECTRIC WATER HEATERS _ _3 _ SINKS WASHING MACHINES U
— HOSE BIBBS SUMPS
•
SIGNATURE
I certify under penalty o/perjury that lam the property owner or authorised agent et the property owner.I certify that to the best of my
knowledge,the information submitted in support e f this permit application is true and correct.I certify that I will comply with all applicable
City of Federal Wag 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 of such claim), which may be made by any •erson, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance of the city,including its a cors and employes, upon the accuracy of the information supplied to
. the city as of this applica n.Nyi_S ??
IGNATURE: ` DATE c�— 6l
Property Owner and/o 7 thorized Agent
o NEW a ADDITION o ALTERATION a REPAIR a,TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a,PISS a NO
• ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO IIP/SEPA/SII? a YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application