04-102579 , , .
C`t, •"' �ay Plumbing Permit #:04 - 102579 -�00 - PL
Comm�_ 4=velopment Services
33530 tst Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: Z�J3.g35.3�50
Project Name: MIRROR LAKE JAVA HUT
Project Address: 803 SW 312TH Suite102 Parcel Number: 072104 9125
Project Description: Insta112-inch floorsink for a tripple sink and run 2.5 inch copper waterIines(hot&cold)
Owner Applicant Contractor
Medina Andres PLUMB SERVE LLC PLUMB SERVE LLC
424 S 60TH ST PLUMB SERVE LLC PLUMB SERVE LLC
TACOMA WA 13300 SE 30TH ST SUITE 105 13300 SE 30TH ST SUITE 105
98408-6443 BELLEVUE WA 98005 (425)562-1431
Plumbing Fixtures
�----�
Description Quantity , __ Description �Quantity Description Quanti �
Sinks 1
� — — ��
PERMIT EXPIRES December 26,2004.
Permit issued on June 29,2004
I hereby certify that the above i form io ' onect and that the construction on the above described property and
the occupancy and the use ' be ' a o ce with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: Date: � — Z S ' �9
� ,�1�� ���//- ' �f� ��l/J'1�//� ��/"'.. /6/�/� �(.�i'/YI�'��� �/�� .
� - THIS CARD IS TO "�'MAIN ON-SITE
CITYOF �.ommunity Developm,,��t Inspection Re�cord
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-102579-00-PL
Owner: PLUMB SERVE LLC
Address: 803 SW 312TH ST Suite 102
FEDERAL WAY, WA 98023-4526
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) ❑ Rough Plumbing(4230) ❑ Gas Piping(4125)
Approved to cover Approved Approved to release test
By Date By �� Date V �d !� By Date
❑ Final-Plumbing(4075)
Approved
By Date (� :�o ay
a►„�� RECEI�lE� . _ ��
Federal Way �-� �� � �—
COMMUN(TY DEVElAPME�f('SER
��� 2 9 2004 pERMIT SF MF C E L E EN FP
33530 F/RST WAY SOUTfI•Po BOX 9778 �p p L I C A T I O N
� FEDERAL WAY,WA 98063-9718 D / /
ss3-�e�a»s�Faxzs �-�z�F FEDERAL A
www.d[ ederdui
UILDING DEPT.
The oilowin is re uired in ormation-an inco lete a lication wili not be acce ted. PZease rint Ie ibl (in;nk�or
- - - - -= i•'_� `a�Yr• • •
� SITE ADDRE,SS So3 S•Gt�. '3v12 7H ST �DE�'IRAC,tJ�1 N kJ.q �gD2 SUITE/UNIT#
i ASSESSOR'S TAX/PARCEL# - ,��2
— — — — — — — _ LOT SIZE(s�
i
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1 J
� � . (Anach sepam(e page for ieng2hy legd desoiptionJ
' � 1 � ' �
T'YPE OF PERMIT ❑ BUII,DING PLUMBING ❑ MECHANICAL
r ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prouide detailed description of work included on fhis pernuY onlu)
II.I�TAti M 7 ���,MOSII`IG ��Q, IA TK.IDDI,E C��AIG IA�/D I�l)11 �L �/L� C0�7Dlr�
T�
GJ�6TFQ.t .it ic�c I-EeT !' �2 CI�a1G.
PROJECT NAME(Name ofBusiness or Owner Las1 Nam�,nYAI l�QS,�Q, �,/�1� ,(�V/{ �� ��,Q i�fl�/
• • 1 • - �
PROPERTY NAME
t PRIMARY PHONE
O WNER /y �
v�
MA LING AD RE S CITY,STATE,ZIP
o� i W�-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFfCE PHONE
� rts � 653 -4�g
MAILING ADDRESS SJ �r.+ CITY,STATE,ZIP CEI.L PHONE
sE'3a �"� /OS' wi9 � o c 1 -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
Z D -¢ �-_L O � � l2 �- g �' �Z � �/ �O� � ) -
CONTRACTORS REGISTRATION NUMBER(copy of card required with eaoh application) EXPIRAT[ON DATE
` � c� � �� Q Q 4 .P 4- — — /U �i �D
APPLICANT COM NA E APPLICANT NAME OFFICE PHONE
��� � � -
I MAILING ADDRESS GTY,STATE,Z(P CELL PHONE
� � �
RELATIONSHIP TO PROJECT FAX NUMBER
4 ❑ Architect ❑ Tenant ❑Agent ❑ Other(Describe) � � _
E
CONTACT NAM PRIMARY PHONE
� _ E-MAIL ADDRESS �
LENDER Per RCW 19.27.095: Lender information is ` Nnt�tE
I required tf proJect va[rce exceeds$5,000
� MAIUNG ADDRESS � CITY,STATE,ZIP
� • t � : 1 � 1 1 • � •
I EXISTING USE PROPOSED USE
iEXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
( SPRINKLERED BUII,DING? ❑ YE,S ❑ NO FIRE SUPPRF.SSION SYSTEM PROPOSED/RF,QUIRED? ❑ YE,S ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHI,INE O TACOMA ❑ PRIVATE(WELL)
E SEWER SERVICE PROVIDER ❑ LAKEHAVED( ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
..�r.�.,.
�
- . . . -
AREA DESCRIPTION EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
FiRSf +
SECOND
THIRD �,
FOURTH
ADDITIONAL FLOORS(DESCRIBE) ;
DECK(COVERED?) �
GARAGE/CARPORT !
HOW MANY FLOORS? T07AL F�STIRG TOTAL PROPOSED iOTAL FASTQlG MD PROPOSED
�
"NEW HOMES ONLY"` NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
►
Indicate number of each type of fixture to be instafled or re(ocated as part of this project. Do not include existing fuctures to remain.
MECfIA1V7(.AL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORAT[VE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�co�«d�� WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES M[SC(Describe�
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS�orTub/Sho�.<rCombo� SHOWERS WATER CIASETS Ro��q MISC(Describe)
DISHWASHERS ♦ ( S[NKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS Battvooms�k: VACUUM BREAKERS ELECTRIC WATER HEATERS
� 1 •
I certify under penalty of perjury that the information furnished by me ts true and correct to the best of my knowledge, and further, thaf I I
am authorized 6y the owner of the above premises to perform ihe work for which the perneit application is made. I further agree to hold !
harmless the City oJ Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such clairr�, which may 6e made by a person, including the undersigned,and f:ied against the City of Federal Way,but only where such claim
artses out of the reliance city 'n iuding its oJficers and empioyees, upon the accuracy of the information suppiied to the city as a part of �
lhts application. '
NAME/TITLE DATE (p—Z�-O�
(Signa re) (Title� ,
RELATIONSHIP TO PROJECT ❑ Owner o Agent ¢�ontractor ❑ Architect ❑ Other
l/ �
FOR OFFICE USE ONLY �
o NEW ❑ADDITION ❑ALTERATION a REPAIR ❑TENANT IMPROVEMENT �
BUII.DING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES o NO
ZONIPiG DESIGNATION CHANGE OF USE? ❑YES ❑NO �
NEW ADDRF.SS REQUIRED? ❑YFS o NO UP/SEPA/SU? ❑YFS ❑NO j
PLAT"TED LOT? ❑YES o NO DEMO PERMIT REQUIRED? ❑YF,S ❑NO
�
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j[3ulletin#l00—March 30,2004 Page 2 of 4 k\F[andouts—Revised�['ern�it Application