17-100282�0 0 2S2
CITY OF h Warm
Federal way PERMIT
coMMuNTYDEvELOPhfENTsERvicEs,� AN 19 - SF MF CO ME EL PL DE ENE)
33325 I)ERAL AVENUE
AY, WA 8063 -90X 9718 ' P P LI CATI O N
FEDERAL WAY. W 98053 -9718
253-835-2607- FAX 253 J
wwuacityo(federal .
The following is required in ormation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS _ 33650 6TH AVE — SUrrE/UNIT # 110
ASSESSOR'S TAX/PARCEL # _ 9264800210
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) _
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
LOT SIZE (st)
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlu)
Add or relocate 12 sprinklers for a new floor layout
PROJECT NAME (Name of Business or Owner Last Nainel
PROPERTY
.: OWNER
CONTRACTOR
PROJECT
CONTACT
LENDER
FARMERS T.I.
PEOPLE INFORMATION
NAME
RIDGEWOOD CENTER
PRIMARY PHONE
MAILING ADDRESS
CITY, SPATE, ZIP
E -MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
Evergreen Fire Protection
Mike Hutchinson
( ) -
MAIIING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CrrY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRAITON DATE
FAX NUMBER
20-05-106411 -00131-
{ ) -
CONTRAt,'TOWS REGISTRATION NUMBER
ZIPMATION DATE
E -MAIL ADDRESS
Evergfp967lz
12/17
COMPANY NAME
Evergreen Fire Protection
APPLICANT NAME
Mike Hutchinson
OFFICE PHONE
(253 ) 3814456
MAILING ADDRESS
CITY, STATE, ZIP
CEIL PHONE
PO BOX 998.
Puyallup 98371
( 253 ) 381 -4456
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
( 253 ) 848 - 0965
NAME PRIMARY PHONE E -MAIL ADDRESS
- 4
Mike Hutchinson (253 ) 381 456 Evergreenfirepro@msn.com
NAME
Per RCW 19.27.095:
Lender igformation is required }f project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
ESISTING USE Office space PROPOSED USE Office ice space
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORN $ 2200.00
SPRINEIRRED BUILDING? x YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGMJNE ❑ PRIVATE (SEPTIC)
V
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ.FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
WATER CLOSETS rroiiet)
SINKS
WASHING MACHINES
FIRST
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
SECOND
❑ NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
❑ YES
❑ 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
m
TMU.E=, e+Sr
mrer. PROPOSED W
mrAZ 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 INCLUDED WITH APPLICATIOM
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (Con -n tai)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (orTub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (bathroom Sinks)
URINALS WSC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS rroiiet)
SINKS
WASHING MACHINES
SUMPS
BUILDING SHELL ONLY? ❑ YES ❑ NO
I certify under penalty of perjury that I am the property owner or authorized agent of the property Droner. 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.
incurred in the
I,further agree to hold harmless the City of Federal Way as to any cl aim (including costs. expenses, and attorneys' fees r '
investigation and dgfense 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 application.
�� °1 , i� - i '?
Sn
SIGNATURE: t, / -.G —�-c -� DATE
Owner and /or Authorized
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\IIandouts\Permit Application