18-105302 r --
' 11
Plumbing
1 ,
Ctityof Federal Way
yDevelopment `' ? Permit #:18-105302-00-PL
Community Development Dept. .�
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax(253)835-2609
Project Name: MIRROR LAKE VILLAGE SENIOR HOUSING BLDG A
Project Address: 31000 9TH PL SW Parcel Number:072104 9087
Project Description: Install plumbing fixtures for new senior housing facility.
Owner Applicant Contractor
MIRROR LAKE VILLAGE LLC TODD SARGEANTWATTENBARGER PETRA INC/PETRA INC OF IDAHO
PO BOX 6961 ARCHITECTS PETRAII927JM(5/16/20)
BELLEVUE WA 98008 11000 NE 33 PL SUITE 102
BELLEVUE WA 980 04- 16310 NE 80TH ST SUITE 200
REDMOND WA 98052
PERMIT EXPIRES Monday,8 July,2019
Permit Issued on Wednesday,January 9,2019
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: Date: 1 iq /
•
• THIS CARD IS TO REMAIN ON-SITE
rey•aeral way
Construction Inspection Record
INSPECTION REQUESTS:(253)835-3050
PERMIT#: 18 105302 00 Address: 31000 9TH PL SW
Project: MIRROR LAKE VILLAGE LLC FEDERAL WAY WA 98023-4515
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.
El Plumbing Groundwork(4190) ® Rough Plumbing(4230) Final-Phambing(4075)
Approved to cover Approved Approved
By Date By Date By Ill') Date 7 14 yo tO
0 Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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,..._ _,A, RECEIVED PERMIT APPLICATION
CITY Of
NOV 0 8 2018 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way 253-835-2607+ FAX 253-835-2609+permitcenter(a,citvoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER1 9 _ _ �) ' i i
O TARGET DATE /
SITE ADDRESS SUITE/UNIT*
e'444 4=� 3 1 000 Ct rte- P1, 5
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL*
$ D -1 Z 1 D 11 - T o 8 7
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT ..(k CL-CZ-0 g, V I LLA(AZ_ 51-067. 0
PROJECT DESCRIPTION
4W 7 LSJ a 6 t 1J A .k. c t/ [ W l-C� �LO& 04,4
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
'1cCi20'.-- L Ak.E V I l..LA-c.IE_ L._L
PROPERTY OWNER MAILING ADDRESS E-MAIL
RD, Bev,- (pet to)
CITY ?f_L ' £ STATE ZIP ZIP RFP
,rtv"
NAME
?ET l41-, PHONE
39(, 11510
MAILING
ADDRESS E-MAIL
CONTRACTOR 1(03 D 1-' O S Yeo ( it za) S em Lt.,ciA/, 6 F raING,11
CITYX
STATE
wP=' ZIP FAX
804 2 .125 3q(p 0/156
WA STATE CONTRACTOR'S LICENSE* EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE
NAME PRIMARY PHONE
-1•250 S A-fZC E, T -WS- 4113 otao&
MAILING ADDRESS E-
APPLICANT f
(l pdd f`1t 33 pi_ i 1 D"Z -1- S ()0.0 e,46,4- -2(',40.41
CITY STATEZIP FAX
4 u
MEL-L -. 1/3-P- 9g00 y ---
NAME PRIMARY PHONE
PROJECT CONTACT 1 -pD 54126-te4 11,T7 115-3 6&'O
MAILING ADDRESS(The individual to receive and M 3 j i-3 10'2- E-MAIL )S 6,i,-),- E u� l�s E�4�.yt
respond to all correspondence �
concerning this application) CITYV k.) STATE
ZIP 6 O FAX
eiy
NAME
PROJECT FINANCING eiSr OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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 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 person,including the undersigned,and filed against the city,
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.
SIGNATURE:
l..:--w ` y DATE !/ U//v
PRINT NAME: I .[) '7E
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $ ,Y26 ( 0°0
Indicate how man o each •e o ixture to be installed or relocated as .art o this ro ect-Do not include existin• ixtures to remain.
.4/0_0_ BATHTUBS(or Thb/Showercombo)35 — LAVS(Hand sinks( [�D TOILETS WATER PIPING
— _ DISHWASHERS ( _ RAINWATER SYSTEMS 1 _ URINALS OTHER(Describe)
_ • DRAINS 14D _ SHOWERS 5- VACUUM BREAKERS
J
_ DRINKING FOUNTAINS 'L _ SINKS(kitchen/Unity) 0 _ WATER HEATERS(DecMc) �j
HOSE BIBBS SUMPS t I WASHING MACHINES 230 TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
=STING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK,
GARAGE ❑ CARPORT ❑
OTHER(descr1be)
- - -------- -----------------
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area m Occupancy Group(s) Construction of
Additional Information
Square Feet Type Stories
TOTAL BUILDING -
TENANT AREA ONLY
IECT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application