10-101860RECEIVOD
Federal Way MAY o 6 2010 PERMIT
COMMUNITY DEVELOPMENT SERVICES
0
SF MF CO ME EL PL DE ENQ
33325 58 5 607E BOX 9718 F E D E RE.II CATI O N
FEDERAL WAY, 7
www cituQfled rWwag.com d" D C
The following is required {iriiiform7ation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY O.
SITE ADDRESS
1010 South 336th Street
ASSESSOR'S TAX /PARCEL # 9 2 6 5 0 1 - 0 0 1 0
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal descrtptioN
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
SUITE , /UPiIT # 112
LOT SIZE (sfi
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING [Z] FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlu)
add heads for new walls and ceilings
PROPERTY
NAME Omni Properties LLC
PRIMARY PHONE
OWNER
CRY, STATE, ZIP
Tacoma, WA 98424
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
19 -91- 101988 -00 -BL
MAILING ADDRESS
CITY, STATE, ZIP
E -MAIL ADDRESS
EXPIRATION DATE
1c) 110
909 S 336th St, STE 103
Federal Way, WA
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
COMPANY NAME
Patriot Fire Protection, Inc.
APPLICANT NAME
John Dacca
OFFICE PHONE
( 253 ) 926 - 2290
MAILING ADDRESS
2707 - 70th Ave E
CRY, STATE, ZIP
Tacoma, WA 98424
CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
19 -91- 101988 -00 -BL
EXPIRATION DATE
r� 1 h
FAX NUMBER
( 253 ) 922 -6150
CONTRACTOR'S REGISTRATION NUMBER
PATRIFP099CF
EXPIRATION DATE
1c) 110
E -MAIL ADDRESS
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
NAME PRIMARY PHONE E -MAIL ADDRESS
John Dacca ( 253 ) 926 - 2290
NAME
Per RCW 19.27.095:
Lender igformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE OF F I C01 7 PROPOSED USE cffl NC-6
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? XLYES FNO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? WYES ONO
WATER SERVICE PROVIDER
SEWER SERVICE PROVIDER
PRIVATE (WELL)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SQ. FT.
BASEMENT
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
DYES D NO
BASIC PLAN? D YES
SECOND
ZONING DESIGNATION
THIRD
D NO
NEW ADDRESS REQUIRED? D YES D NO
ADDITIONAL FLOORS (DESCRIBE)
D NO
PLATTED LOT? D YES D NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
D NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ERISTI116
PROPOSED
TOTAL
TOTAL EXISTING SF
TOTAL PROMS= SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE 17VCLUDED WITH APPLICATTOM
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
LAVS (Bathroom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (Commemtaq
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 certify that to the best 4f 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, orfederal 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 apart of this app4a0A. /-1
SIGNATURE:
Owner and /or Authorized
FOR OFFICE USE ONLY
D NEW D ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUIIAING SHELL ONLY?
DYES D NO
BASIC PLAN? D YES
o NO
ZONING DESIGNATION
CHANGE OF USE? D YES
D NO
NEW ADDRESS REQUIRED? D YES D NO
UP /SEPA /SU? D YES
D NO
PLATTED LOT? D YES D NO
DEMO PERMIT REQUIRED? D YES
D NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Permit Application