10-100196CITY OF 0---LDO- `
Federal way JAN Is"" PERMIT
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE E)
33325 FEDERAEMIE SOUTH • PO BOX 9718 �„, � �� CATI O N
FEDERAL WAY, WA 9� F
253 - 835 -2607• FAX 25 ��
ww w. ciWo(federo'wau. com
The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY •. •
SITE ADDRESS 1010 S 336th Street SUITE /UNIT # 330
ASSESSOR'S TAX /PARCEL # 9 2 6 5 0 1 - 0 0 1 0 LOT SIZE (sff) _
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for Lrirgthy legal descriptioN
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING F,71 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlll)
add /relocate heads for new walls and ceilings
PROJECT NAME (Name of Business or Owner Last Namel '' ` So La, u ')-s
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
NAME
PRIMARY PHONE
Omni Properties
Patriot Fire Protection, Inc.
MAILING ADDRESS
CITY, STATE, ZIP
E -MAIL ADDRESS
909 S 336TH ST SUITE 103
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
Patriot Fire Protection, Inc.
APPLICANT NAME
John Dacca
OFFICE PHONE
( 253 ) 926 -2290
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
2707 70th Ave E
Tacoma, WA 98424
( ) -
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent Other
( 253 ) 922 -6150
NAME PRIMARY PHONE E -MAIL ADDRESS
John Dacca ( 253 ) 926 - 2290
NAME
Per RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE O%oLe`/C F� PROPOSED USE OE F1 CC
It
EXISTING EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ -750
SPRINKLERED BUILDING? 5aYES RNO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? M YES E:]NO
WATER SERVICE PROVIDER RIAKEHAVEN RHIGHLINE F-ITACOMA F-JPRIVATE (WELL)
SEWER SERVICE PROVIDER LAKEHAVEN HIGHLINE I— (PRIVATE (SEPTIC)
* PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
SECOND
❑ NO
ZONING DESIGNATION
THIRD
MS'S �- �"Cw. -s T�A,v4NT sVwct-.
CHANGE OF USE?
S S S,L N
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
UP /SEPA /SU?
❑ YES
DECK (❑ COVERED OR ❑ UNCOVERED ?)
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
GARAGE ❑ CARPORT ❑
❑ NO
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTZ4
TOTAL=MWG SF
TOTAL PROPOSED SF
TOTAL 8F
"NEWHOMES 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 extstingfixtures to remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICAT(ON)
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAYS (Bathroom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (Commercial)
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (Tm)et)
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 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 Cncluding 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 oppiicatWW.,,1 1
SIGNATURE:
-A -----
xperty Owner and /or Authorized
/J/ f ZU,la
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 —January 1, 2008 Page 2 of 4 k\Handouts\Permit Application