08-102175CM OF �tRECEIVR) 060102- f 7 5
Federal Way�,A/� PERMIT
,0.""nrneFESOP.�n�rLAAY 0 5 2008 SF MF CO ME EL PL DE EN P,
33325 FE ERAL W SOUTH -06 -9718 8 AP ' � I CATION
FEDERAL WAY, WA 98063 -97/8 D
253_835 -2607- FAX 253- 835 -2609.
CITY ®F FEDERAL A
The following is required' j ration -an incomplete application will not be accepted. Please print legibly (in ink) or type_
SITE ADDRESS 2403 S. 304th St. SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 0 � Z_ j ja _+ ' �� LOT SIZE (Sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aaarb seP --PW )br I mv* kgd de—"—)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ® FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description ofwork included on vapermit on
New NFPA 13D fire sprinkler system
PR06JECT NAME (Narne otQusines or Owner Last Name ) Mathiason Residence
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
U i✓1 3V
PRIMARY PHONE
o6
��
_1
MAILING ADDRESS
CITY. STATE, ZIP
I E-MAAAIL ADDRESS
MAILING ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Evergreen Fire Protection, Inc.
Mike Hutchinson
( 253 ) 848 0146
MAILING ADDRESS
CYCY, STATE, ZIP
CELL PHONE
NAME
Mike Hutchinson
253 3814456
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
20- 05- 106411 -00 -BL
12/31/08
( 253 ) 8480965
CONTBACTOR'S BB GISTBATION NOMBZR
EXPIRATION BATE,
EMAIL ADDR S
Evergfp967lz
12/08
COMPANY NAME
Evergreen Fire Protection, Inc.
APPLICANT NAME
Mike Hutchinson
OFFICE PHONE
253 848 0146
MAILING ADDRESS
10509 64th ave. E., Puyallup
C; STATE,ZIP
Puyallup, 98373
CELL PHONE 381 4456
253
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant N Agent ❑ Other
FAX NUMBER
( 253 ) 848 0965
NAME
Mike Hutchinson
PRIMARY PHONE
253 3814456
E-MAIL ADDRESS
NAME
Per RCIV -19.17.1995.
Lender in ormation is required 1 ro ect value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
(
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 5000.00
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSE/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGH LINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGH LINE 13PRIVATE (SEPTIC)
AREA
NUMBER OF FLOORS
"NEW HOAX'S ONLY** NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
sr
Indicate. number of each type of fudure to be installed or relocated as part of this project. Do not include ezistingflxtures to remain,
Value of Medianical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLfCAT10Nf
AIR HANDLING UNITS EVAPORATIVE COOLERS OAS PIPE OUTLETS WOODSTOVES
1313 .QS BANS GAS WATER HEATERS
BOILERS FIREPLACE INSERTS MISC (Describe)
HOODS pm..,dy
COMPRESSORS
FURNACES RANGES
DUCTS. GAS LOO SETS REFRIO. SYSTEMS
BATHTUBS I0rnb/Z1w~c.wj4
LAVS (Btlbne="
URINALS
DISHWASHERS
RAINWATER SYST�
(Describes
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS inaeq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
.
I 9-ft under penalty of Perjury that I am the property owner or authorised ' agent the Prop" knowledge, the information submitted in ag � P p" Owner I cwt* that to the best of my
City Of hderai Wsgh regulations I'Ort y this permit application is true and eorreoL I eertyk that I win compIg with all applicable
does not remove the owners res onsibitl the work aathoetsed by the issuance q f a permit, I understand that the i+suanoe of this permit
run P ty for compliance with local, staty or federal laws regulating construction or OnsiroUtne i laws.
I /rather agree to hold harmless the City of Pederal Way as to any claim ilncluding costs, expenses, and attorneys• fees incurred in the
investigation and dtfonse of such otaimJ, which may be made by any person, inetuding the undersigned, and Plod
when such claim arises out of the reliance of the city, including its o eers and • to s agatns! the city, but only
the city as apart of this application. mP y ++► upon the accuracy o f the'information supplied to
SIGNATURE:
o NEW a ADDITION
a ALTERATION
o REPAIR o TENANT ncmvzMENT
BUILDING SHELL ONLY?
ZONING DESIGNATION
a YES o NO
BASIC PLAN?
CHANGE OF USE?
13 YES
a YES
o NO
o NO
NEW ADDRESS REQUIRED?
PLATTED LOT?
a YES o NO
o YES o NO.
UP /SEPA /SU?
DEMO PERMIT REQUIRED?
o YES
o YES
a NO
o NO
Bulletin #100 — January 1, 2008 Page 2 of 4
bElandoutsTennit Application