12-103415 CITY OFA { \'!-
Federal Way RECD — _ — /} f
COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF CO ME EL PL DE ENFP
33325 8nt AVENUE SOUTH•PO BOX 9718
FEDERAL3F X^253 2609 JUL APPLICATION
www.cago((ederalwaq.com
t nF �DERg1 WAY
The following is required+ oi'Mas an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 4342 Sw.30th-St—30 3-ti" St—
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 1121039071 -
-— —— LOT SIZE(sj)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legs!descriptlBN
In PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION 0 ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
New 13D fire sprinkler system
PROJECT NAME(Name of Business or Owner Last Name) Reagan Residence
• PEOPLE INFORMATION
PROPERTY NAME
OWNER Kirk&Denise Reagan PRIMARY PHONE
MAILING ADDRESS I CITY,STATE,ZIP ( )
E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME
Evergreen Fire Protection OFFICE PHONE
Mike Hutchinson ( )
MAILING ADDRESS CITY,STATE,ZIP
CELI,PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ( )
EXPIRATION DATE FAX NUMBER
20-0S-106411-OOBL ( )
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
Evergfp967lz 12/12
APPLICANT COMPANY NAME APPLICANT NAME
Evergreen Fire Protection OFFICE PHONE
Mike Hutchinson (253 ) 848-0146
MAILING ADDRESS CITY,STATE,ZIP
10509 64th Ave.E. Puyallup 98373 (2EL53xoNE53 ) 381 4456
RELATIONSHIP TO PROJECT
( 2
0 Architect ❑Tenant ElAgent 0 Other FAX NUMBER
( 253 ) 848 - 0965
PROJECT NAME PRIMARY PHONE
E-MAIL ADDRESS
CONTACT Mike Hutchinson
(253 ) 381 _ 4456 Mike@Evergreenfireprotec4n.com
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS
CITY,STATE,ZIP
PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 7,000.00
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? (YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• • PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT SQ.FT. SQ.FT. SQ.FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS I MISTING I PROPOSED f 1 TOTAL TOTAL EXISTING SF
TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
�
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS
BBQS WOODSTOVES
FANS GAS WATER HEATERS M1SC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS
MISC(Describe)
DISHWASHERS
RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS
ELECTRIC WATER HEATERS millet)
WASHING MACHINES
HOSE BIBBS SUMPS
....,m.... ..µ..nm,.. ...,�... SIGNATURE
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(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 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 app cation. /j /
SIGNATURE: \AA ` J DATE ` I
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW a ADDITION a ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN?
a YES a NO
ZONING DESIGNATION CHANGE OF USE?
o YES ❑NO
NEW ADDRESS REQUIRED? c YES ❑NO UP/SEPA/SU?
❑YES a NO
PLATTED LOT? o YES [:I NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin#100—January 1,2008 Page 2 of 4
k\l-Iandouts\Permit Application