06-103992 (RECEIVED
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Federal Way CITY OF FEDERAL WPERMIT SF MF CO ME EL PL DE EN FP
COMIYUNITYDEVELOPMENT SERVICES BUILDING DEPT,
3332E D AVENUE ALWAY,SOUTH 8 PO APPLICATION
FEDERAL.WAY,WA 98063.9718
253.835-2607•FAX 253-835-2609
www.cituoffederalwaU.com
The ollowin• is re•uired i ormation-an incom•lete a••lication will not be acce•ted. Please 'tint le•ibl (in ink)or •e.
• PROPERTY INFORMATION
SITE ADDRESS 35425 16TH AVE SOUTH FEDERAL WAY SUITE/UNIT#
2921049077
ASSESSOR'S TAX/PARCEL# - _ _ _ _ LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING XXXIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide det fled description of work included on this permit onlu)
INSTALL AUTOMATIC FIRE SPRINKLER SYSTEM.
PROJECT NAME(Name of Business or Owner Last Name) LOWE I S - FEDERAL WAY
PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER LOWES HIW INC ( ) -
MAILING ADDRESS CITY.STATE,ZIP
1530 SARRADAY SUITE 140 CARLSDAD, CA 92008
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
SMITH FIRE SYSTEMS SANTIAGO LAVIN (253 ) 926-1880
MAILING ADDRESS CIT.',STATE,ZIP CELL PHONE
1106 54TH AVE EAST TACOMA WA 98424 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
19-87-000055-00-BL 12 / 31 / 06 (253 ) 926-2350
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
SMITHFS1360T 11 / 02 / 06
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
SAME AS ABOVE ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
SANTIAGO LAVIN (253 ) 926 -1880 SLAVIN@SMITHFIRE.0 M
LENDER PIS ':I; sS 0e4 (ulo is NAME
',",!;*400:00:4#..tv4ue r ends S'J f) D.
MAILING ADDRESS ,. CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE 1 �( Or"
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF'PROPOSED WORK $34 y BTU
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 /YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
III i ,
PROJECT FLOOR AREAS
AREA DESCRIPTION NSA EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
=arum PROPOS= TOTAL r TOT !XIS I(b se'-: .TOT,=PaOPOSSD 6P TOTAL Si.• - .
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $_,
FIXTURES
__..._._..._Indicate number of each type offLYture to be
installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL N/A
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS Or Tub/Shower Combo)
SHOWERS WATER CLOSETS rrouet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 jtled against the City of Federal Way,but only where such claim
arises out of the reliance of the city, incl ing its o cern and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE - DATE 8/10/06
( y at TONT TEBAR FOR SMITH FIRE (Rile)
RELATIONSHIP TO PROJ ,U....Atvrier 0 Agent ) Q ontractor 0 Architect 0 Other
�• a;ICE S OIILY
❑N n ADDITION( ❑"ALTERATION o REPAIR d TENANT IMPROVEMENT
BUILDINGS TEL ONLY? n Y o N`O IO PLAN? n YE,S o NO
C)NII4o DESI NA ION CHANGE OF USE? n YES ❑NO:
NEW AD 11RESS I TARED? a YES. d NO UP/SEPA/SU? n YES a NO"
O PERMIT UNO
1p'I+11"I'Ir 7t LQ'I' a YE.` a NO DSM ILMIWIRED? ❑YES a
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application