21-102037-Permit AppCITY OFVA�k PERMIT APPLICATION
Federal Way PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
PERMIT NUMBER 2 1- 1 0 2 0 3 7- C O
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
33702 21st Avenue SW, Federal Way, WA 98023
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 105,000
9 3 0 1 0 0- 0 0 1 0
TYPE OF PERMIT
BUILDING I$ PLUMBING EX MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Fred Meyer Grocery Pick Up Relocation - Federal Way #111
Relocate (E) Grocery PU area inside FM store. Online Grocery orders rec'd & processed in
PROJECT DESCRIPTION
Detailed description of work to
this area. (N) Walk-in cooler installed & (N) Reach -in freezers installed. (N) sliding door inst
Opening cut into (E) wall between old tenant spc & (E) FM w/(N) pair floppy doors installed.
be included on this permit only
Staging area will be used for storage. Parking lot-10 spcs ID'd as PU parking,(E) will be con
NAME
PRIMARY PHONE E)acR O Stf
Fred Meyer Stores - Charlie Nordloh
206.808.0305
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
1014 Vine St.
charlie.nordloh@kroger.com
CITY
STATE
ZIP
Cincinnati
OH
45202
NAME
TBD
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
Pam Deegan
PRIMARY PHONE
360.953.8517
APPLICANT
MAILING ADDRESS
2300 E. 3rd Loop, Ste. 110
E-MAIL
pam@westernconstruction.co
CITY
Vancouver
STATE
WA
ZIP
98661
FAX
360.694.7818
NAME
PRIMARY PHONE
PROJECT CONTACT
Pam Deegan
360.953.8517
MAILING ADDRESS
2300 E. 3rd Loop, Ste. 110
E-MAIL
pam@westernconstruction.co
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
Vancouver
WA
98661
360.694.7818
PROJECT FINANCING
NAME
N/A
® 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 authorized 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 authorized 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 apart of this application.
Digitally signed by: Pamela A. Deegan
DN CN = Pamela A. Deegan email = pam@westernconstruc[ion com C =
Pamela A. D
e e g a n AD O = Western Construction Services
SIGNATURE' Date 2021.05.2807:55:46-0800' DATE 05.21.21
PRINT NAME: Pamela A. Deegan
Bled.
lert
idrd
Bulletin #100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
$ 15,000
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 1
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$ 5,000
Indicate how many of each type offiixture
to be installed or relocated as
part of this project. Do not include existiggftxtures to remain.
BATHTUBS (oriub/showercombo)
LAVS (Hand sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
2 OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
Condinsate Line
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Eiectric)
WasteLLine/Vent P
2
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
N/A
Water District
Public
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
M (No Change)
675,858
X Yes ❑ No
i i Yes i No N/A
COMMERCIAL - NEW/ADDITION N/A
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
1497 Sq. Ft.
M
V-g
1
Bulletin #100 — February 19, 2020 Page 2 of 2 k:AHandouts\Permit Application