02-103066 I S
City or Federal Way
Community Development Services Plumbing Permit #:02 - 103066 - 00 - PL
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661 4129 Inspection request line: 253.835.3050
Project Name: SHOGUN
Project Address: 31140 PACIFIC S Parcel Number: 785360 0185
Project Description: PL-Move exiting fixtures to new location.
Owner Applicant Contractor
HOUSE OF SHOGUN INC AWN THE SIDE PLUMBING HIGH VALLEY HOMES
31140 PACIFIC HWY S AWN THE SIDE PLUMBING HIGH VALLEY HOMES
FEDERAL WAY WA 13015 144TH AVE SE 12264 210TH PL SE
98003-4905 RENTON WA 98059 (425)351-2571
Plumbing Fixtures
i::: .1,':.: Description , Cqumty sprOs .s+vriptia _,,`i,.: Quantjt r , :Description :';_' :.,.! Quantity
Dishwashers I 1 Drains 2 Sinks 3
CONDITIONS:
The applicant needs to provide some verification they spoke with or have approval to move the bar per the State Liquer
Control Board prior to issuance.
PERMIT EXPIRES February 1,2003,IF NO WORK IS STARTED.
Permit issued on August 5,2002
I hereby certify that the above information is correct and that the cons' ction on the above described property and
the occupancy and the u - will be in accordance with tile,laws rules • d regulations of the State of Washington and
the City of FederalW /
Owner or agent:// %�// ,Z,/ 7 J/- -/ — Date: �� O�_
S
f744 Ogill
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Kofi 1s541.6 1614-r/
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`r'°` G CONS-TRUONPERMIT APPLICATION
• E_110 L "icll �� D� s APPLICATION NUMBER: Q j o!d p (
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uV FEY •
7 4 C 4f IS L;C(�.LSG APPLICATION NUMBER: _ -
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6tG 1 iZ C For Cpyl�✓ APPLICATION NUMBER: -
**The following is required information-Please print(in ink)or type**
le" 1!)
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
•
SITE ADDRESS: 3/j d ?A..c„ l� 5 - ASSESSOR'S TAX/PARCEL#: -
ll
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
..�.- -.•-. • ■ PRO3ECT INFORMATION'
TYPE OF PROJECT(This application): ❑ BUILDINGPLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL b ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Pr vide detailed description): Mo v to £>[ ' (hof (`I 4,--to la
h e_i_.0 r�o a`f't 0% ��
PROJECT NAME: A �c"LG G'l
■ PEOPLE INFORMATION r•
PROPERTY OWNER: NAME //// DAYTIME PHONE:
Pea-v-i C ��► 4 , C ( 0 a. )3'I -.S2Z
MAILING ADDRESS(STREET DRESS; ,STATE,ZIP
CONTRACTOR: NAME: DAYTIME PHONE:
�`` `s �►�� �S 5)3S( ,r7/
MAI NG ADD S( EET A RESSY, TE,ZIP): EVENING PHONE:
,t2-6,Ce 0(d 7"h 7l 5� .Zs ti/4 ergoz--7 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: f FAX NUMBER:
- ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME), / / DAYTIME PHONE:
1.,&( ,/ Ee4 c 1 /A7m 4 y ( ) -
NG ADDR S(STREET ADD ESS;CITY,STATE,ZIP): EVENING PHONE:
/3C)/S /1114f? ,4c'i5e &' /;) , ,5 ( )
RELATIONSHIP TO PROJECT: 4� JJ FAX NUMBER:
❑ ARCHITECT ❑ TENANT '4 OTHER(DESCRIBE):S( ' aibi /4tc. (sf,2S )?vi d
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT IkCONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: /RCdte.,c.na/ �iw EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: A�✓ ,, �3yv PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:KYES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTIO•LY** •
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND 11600
THIRD tf
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: 41000
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)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) a, SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
- ■ "DISCLAIMER/SIGNATURE BLOCK
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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises •ut of the reliance of the city,including its officers and employees,upon the accuracy
of the informatio uppliedt the. a p., of this application.
G
NAME/TITLE: �., .,,,., it .��✓ DATE: 7/i' L
❑ PROPERTY OWNER 0 APPLICANT AcONTRACTOR
;fFOR OFFICE USE ONLY:1
#M a CI ADDITION a❑ALTERATION hTENANTpIMPROVEMENT -_
L. NSUSTCODE" = �s Via= = r
[Iv
`yb'I G°� GN%1 ON = :� _ _ ===*� BUI:1510 HELL;ONLY? D,tYES, >�.ti0
3 � " ESIG.L..,! x �v' BAS C ? _ c."ESI _.i O` } y
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- ECON . MfrafhSHIP" � > NENEWADDREsitEQIiREUYgal5 C
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COMMUNITY DEVELOPMENT SERVICES.33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cttvotfederalway.com
Section 3
g Plumbing 0 Electrical
-FIXTUnDESCRIPTIO O FIXTURE FEE(B) NUMBER"OF UNITS(C)`;.' ` "."" TOTAL"(D)
I I-I010,5':w
3. 53a c5
( 7411
TOTAL COLUMN(D):
Plumbing
$22.50+{ X$8.00/fixture}= Estimated Permit Fee
Estimated Permit Fee
X .65 = Estimated Plan Review Fee
Miscellaneous Fixture Charge:
OR
Electrical
Total Column(D)
Estimated Permit Fee:
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50+ X.35 =
Section 4
❑ Plumbing A Electrical
FIXTUyRE DESCRIPTION(A) FIXTURE FEE(B) NUMBER OF UNITS(C) TOTAL(D)
YOUG l S c e L,.rui* CocW
o-44 Z2,0/4i t0 s
TOTAL COLUMN(D):
Plumbing
$22.50+{ X$8.00/fixture}= Estimated Permit Fee
Estimated Permit Fee
X .65= Estimated Plan Review Fee
Miscellaneous Fixture Charge:
OR
Electrical
Total Column(D)
Estimated Permit Fee:
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50+ X.35 =
Section 5
0 Demolition ❑ Engineering ❑ Other Fees
Estimated Permit Fee:
Bond Amount:
Estimated Permit Fee:
Bond Amount:
Estimated Permit Fee:
Bond Amount:
Estimated Permit Fee:
Bond Amount: Bulletin#101-January 4,2002
• •
Permit Fee Estimate Worksheet
Section 1
0 Building Permit 0 Mechanical Permit 0 Are Prevention System Permit
•
PROPOSED VALUATION: 1/500(-,
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
{Valuation from permit application-base fee increment}/1000 Round up to nearest whole number
(c){ }/1000 = (d)
OR
For valuations between$501.00 and$2,000 only:
{Valuation from permit application-base fee increment}/100 Round up to nearest wt$le number
(c1){ /S -_ }/loo = (d) / SQ
Value from(d) value from(b)
(e) X _ (0
Base Fee from(a) Value from(f) Permit Fee
Permit Fee: + = (9)
Permit Fee from(g) Plan Review Fee
Plan Review Fee: X .65 = (h)
Permit Fee from(g) Surcharge Fee
FW Fire Department Surcharge: X .15 = (i)
(COMMERCIAL ONLY)
Section 2
0 Building Permit 0 Mechanical Permit ❑ Fire Prevention System Permit
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
{Valuation from permit application-base fee increment}/1000 Round up to nearest whole number
(c){ }/1000 = (d)
OR
For valuations between$501.00 and$2,000 only:
{Valuation from permit application-base fee increment}/100 Round up to nearest whole number
(ci){ }/100 = (d)
Value from(d) value from(b)
(e) X = (f)
Base Fee from(a) Value from(f) Permit Fee
Permit Fee: + = (g)
Permit Fee from(g) Plan Review Fee
Plan Review Fee: X .65 = (h)
Permit Fee from(g) Surcharge Fee
FW Fire Department Surcharge: X .15 = (1)
(COMMERCIAL ONLY)
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129