05-102981 RECEIVED
7 A JUN 2 3 2005
101053-t'�}
Faf I _ -
COMMUNITY DEVELOPMENT SERVICES BUILDING DEPT. SF MF CO ME EL PL DE EN fle
33325 8*"AVENUE SOUTH•PO BOX 9718 APPLICATION
FEDERAL WAY,FAX
53-835-2 0 7... ."--7.*.\\......__..............1„, .H.........,
FEDERAL
5 L WA FAR 253-635-2609
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The of . , is - fired , ,n-an -, ,tete a' 'lication will not be , -- ,ted. Please , t le, 't_ n in or j, .
• PROPERTY INFORMATION
SITE 1goo SboTH �314T S I IREET FEDERAL WA`4 NIT
L
ASSESSOR'S TAX/PARCEL t D I 0 4 _ ( a 5 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) RE h'l D D EL EX 1ST I Nis 6LDCr
(attach seprate pagefar len"legal description)
. PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING >(FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
RE I'IDID EL EX(STI N& 13LDG— ADO SIX_ NELJ ERZ(NI<LER HEADS
I N NELl FREEZER /LOOLEa-,
PROJECT NAME(Name of Business or Owner Last Name) WA L M ART
• PEOPLE INFORMATION
PR
OPERTY
ERRS NAMEWA L M A RT PeMPT,7 -1503
MAILING ADDRESS CMY,STATE.ZIP
MOD SOL�H 314 STREET FEDERAL WA`I WA 18DO3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
COSCO FIFIE PRCTE 0I-( 13RIAN Sif1VI7F025)B27 - % +
109 ADDRESS 117 PLACE M E KISRKLAN D L4 9P 1 CELL PHONE
Z OFO FEDERAL WAY BUSINESS LICENSE 8MBER e°— - 1 EXPIRATIOND��5 FAX NUMBER
CONTRACTOR'S REEGISTRTRATION NUMBER(copy of card required with each application) /EXPIRATION DATE
,. os Lo f P 1 1 O CIM 12_' 3( '05
APPLICANT COMPANY NAME APPLICANT NAME OFFIC PHO E 1
COS Co FIRE PROTELTIC I 13RIAN SLHULLE (42 )3Z7 -%54
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1 D 1 D 117m PL NE I<1Rl<UNID WA.1E 3.3 (-/A ) -
RELATIONSHIP TO PROJECT /,� FAX NUMBER
0 Architect 0 Tenant 0 Agent Other(Describe) SUB Lai (425) SZ7 -7474
CONTACT NAMEB R I AN SC H UL2_E Q )HONE
( - 96 54 E-MAIL ADDRESS
LENDER Per RCW 19.27.095: Lender lrfforntation is NAME S Z
required>(fprclect value exceeds$5.000 IA A
MAILING ADDRESS CITY,STA ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE �7
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ I /6xO t DU
SPRINKLERED BUILDING? RYES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? It(YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS �°fO TOTAL TOTAL ado It TOTAL eeorwm o TOLL RV
**NEW HOMES ONLY" NUMBER OF BEDROOMS MATED SELLING PRICE $
FLXTURES
Indicate number of each type of jiacture to be ins • -• or relocate• 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 ••DS(canmenyaq WOODSTOVES
BOILERS FIREPLACE INSERTS RAN S MISC(Describe)
COMPRESSORS FURNACES GAS WA R HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUB or'Nb/shower Combo' SHOWERS WATER CLOSETS(rodeo MISC(Describe)
DISHW,-HERS SINKS DRINKING FOUNTAINS
G 'lPE OUTLETS SUMPS RAINWATER SYST
ASHING 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.NAME/TITLE � DATE 6-22.-O, �
{J
(Signature) (Title)
RELATIONSHIP TO PROJECT o Owner ❑Agent Contractor ❑Architect o Other
USE ONLY
o NEW u ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BIIIIAING'SHELL ONLY? o YES a NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑'YES a NO
NEW ADDRESS REQUIRED? c YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES a NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application