05-104253 tY of Federal Way
Commun ty Development Services Plumbing Permit #: 05 - 104253 - 00 - PL
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection reque ne: (253) 8 73050
Project Name: FRED MEYER
Project Address: 33702 21ST SW '. ce . ber: '30100 00
Project Description: Installation of new drains and piping tost ,
Owner Applicant \ Intractor ik
TEXAS COMMERCE BANK NATON PORTLAND MECHANICAL CONTRS PO D ME ICAL S INC
33702 21ST AVE SW 2000 SE HANNA VESTER DR SE HA VESTER DR
FEDERAL WAY WA MILWAUKIE OR 9 ILWA K 2
98023-7762 (503)6 6-
•'ng Fixture
2\\-\\I!
Description Quant' V rip . jQuan Description ,Quantity
Drains ® v
PERMIT EXPIRES September 6,2007.
Permit issued on September 6,2005
I he rtify that the abov rmation is correct and that the construction on the above described property and
t upancy the use will be in accordance with the laws,rules and regulations of the State of Washington and
the of al Way.
Owner o t: ) 2?Z4 , L.P70 '4E Date: g —6 - Q ` .---
4k6 THIS CARD IS Tr REMAIN ON-SITE
CITY OF `"
Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-104253-00-PL
Owner:
Address: 33702 21ST AVE SW
FEDERAL WAY, WA 98023-7762
This card is part of your required inspection documents. 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.
(❑ Plumbing Groundwork(4190) u, Rough Plumbing(4230) ❑ Gas Piping(4125)
IApproved to cover Approved Approved to release test
By ji Date By$ Dateq By Date
0 Final-Plumbing (4075)
Approved
By Date
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„,„„,,,,116„. RECEiVip
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Federal Way PERMIT
Alli 22CUUS SF MF CO MEELOIEENFP
crw,vrOvn Y DEVELOPMENT SERVICES
3J32F FEDERTM AL
A SOUTH•PO BOX 97I8 p LI CATI O N
FEDERAL WAY.WA 98063-97TY OF FEDER TD
/ 0 Silill
253 835 wu'u'.607•FAX 253-q.corn O9 BUILDING DEPT. '
u�uu.clhloftederalwati.corn
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The ollowin. is re.uired in ormation-an incom.lete a..lication will not be acce•ted. Please .Tint 1-•, .,i (in ink)or p •.
^� n /• PROPERTY`j� INFORMATION, J, /'
SITE ADDRESS 23 7 )a o?/,S i 4/ei a>` SW �de�� &ki(( Q8O 3 SUITE/UNIT #
ASSESSOR'S TAX/PARCEL# - / LOT SIZE (s)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
MI PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING fel PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
T0S-f--e-l/ 'flew d ra i c * / : ,i
PROJECT NAME(Name of Business or Owner Last Name) rrt Lt /7 eye V'
• PEOPLE INFORMATION
PROPERTY NAME...- m PRIMARY PHONE �j(� l�
OWNER 1--red / / !e v/y- ��3 ) ( ,3�-D 4 't
MAILING ADDRESS / CITY,STATE,ZIP
3n. (.) E o3�na ifizx `tea r>v/aro/ OZ C)7 )
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
;) ( 4 C ' --Z1h010/) (51 3 )&.-6 —7,60
MAILING
(/ADDRESS S {{ //� ��"C(y�/�( CITY,STATE,ZIP ° /�� /" CELL PHONE
CITY 6 FEDERAL WAY LBUSINESS/I nim NUMBER RVcfr 6. gi 1 GI OfV ofDAT / 7i 1FANUMBER
/ / (,c78 )6s-S- -Cb,20
)
2 1-_ -L. `. - Cc1 Li L B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
1 o - -v t. fix K a /,71 / 06,
APPLICANT COMPANY NAME e APPLICANT NAME OFFICE PHONE
-5Cu 1A--e oil 6_,--UZ-Z_. ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant ❑Agent 1E Other(Describe)SU6e 0 iii..--fes:- - ( ) -
CONTACT NAME ..---- (� PRIMARY PHONE E-MAIL ADDRESS
JO.yin‘, JO 13 ( ) '�'s � - `710 ,\Gym(e� (�POrrlahantectweta`
LENDER Per RCW 19.27.095: Lender information is NAME Bolt
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) ,
IN DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE o PRIVATE(SEPTIC)
• •
a• • ^ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. Sg. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**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 $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSIeIb(Toilet) \ MISC(De cribe)
DISHWASHERS SINKS DRINKING FOUNTAINS v)bc7>R
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 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. •
`�J �y���,
NAME/TITLE �' .2.'11 ' ! 2l.` C'tC DATE I cj- LI S
(Signature) (flUe)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent 0 Contractor ❑ Architect pik Other•'LI b Co n ply/.(.51-t11''
FOR OFFICE USE ONLY •
❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? a YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—January 7.2005 Page 2 of 4 k\Handouts\Permit Application