09-102422O
Federal Wag E C E 1g , V E Q� E RM IT SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33325 6FH
DE ALW YSWA 98063-9718 9 7 1 J UN 2 b z p p Ll CATI ON
253 - 835 -2607• FAX 253- 835 -2609
www.ciftloffederalwaLl.com
The followi =q d In Ml'- cdthplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY •• •
SITE ADDRESS 1010 South 336th Street SUITE /UNIT # 102
ASSESSOR'S TAX /PARCEL # 9 2 6 5 0 1 _ 0 0 1 0 LOT SIZE (sffl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate pa9e.(r lengthy legal descriptioN
PROJECT • ' •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Q✓ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
add heads for new walls and ceilings
PROJECT NAME (Name of Business or Owner Last Namel Wolf Chiropractic
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
V
APPLICANT
PROJECT
CONTACT
LENDER
NAME
PRIMARY PHONE
Omni Properties
Patriot Fire Protection, Inc.
MAILING ADDRESS
CITY, STATE, ZIP
E -MAIL ADDRESS
909 S 336th Street STE 205
Federal Way, WA
2707 - 70th Ave E
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Patriot Fire Protection, Inc.
John Dacca
( 253 ) 926 - 2290
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
2707 - 70th Ave E
Tacoma, WA 98424
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
19 -91- 101988 -00 -BL
12 -31 -08
( 253 ) 922 -6150
CONTRACTOR'S REGISTRATION NUMBER.
EXPIRATION DATE
E -MAIL, ADDRESS
PATRI FP099CF
10 -5 -08
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Patriot Fire Protection, Inc.
John Dacca
( 253 ) 926 -2290
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
2707 70th Ave E
Tacoma, WA
( } -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent Other
( 253 ) 922 -6150
NAME PRIMARY PHONE E-MAII. ADDRESS
John Dacca ( 253 ) 926 - 2290
NAME
Per RCW 19.27.095:
Lender i>r1forination is required >(f project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE Dr—P( e&-' PROPOSED USE
o�
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? �S Fj NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED ?kYYES �NO
WATER SERVICE PROVIDER []LAKEHAVEN ❑HIGHLINE ❑TACOMA PRIVATE (WELL)
SEWER SERVICE PROVIDER
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SQ. FT.
BASEMENT
❑ NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY?
O (p0
SECOND
YES
o NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
ADDITIONAL FLOORS (DESCRIBE)
NEW ADDRESS REQUIRED? ❑ YES o NO
UP /SEPA /SU?
DECK (❑ COVERED OR ❑ UNCOVERED ?)
o NO
PLATTED LOT? ❑ YES o NO
GARAGE ❑ CARPORT ❑
❑ YES
o NO
NUMBER OF FLOORS
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rxoroern
rornt
rorv. s>�rnvo sr
rorv, rxorosev sr
rornc sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing futures to remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAVS (Bathroom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (Commercial)
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (Toilet)
WASHING MACHINES
WOODSTOVES
MISC (Describe)
❑ MISC (Describe)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert{)y that to the best of my
knowledge, the igformation 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 ir1formation supplied to
the city as a part of this app
J�cSodyl
SIGNATURE:
?ronerty Owner
6 -2S- d`J
FOR OFFICE USE ONLY
❑ NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES ❑ NO
BASIC PLAN?
YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED? ❑ YES o NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT? ❑ YES o NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 Mandouts\Pennit Application