05-100923 • ir 5- -� 0 �
Way PERMITE EL PL DE E P
COMMUNITY DEVELOPMENT SERVICES SF MF CO M
33530 FIRST WAYWA • BOX9718 APPLICATION TD
FEDERAL WAY,,WA 980663-9719718
253-661-4115•FAX 253-661-4129
www.cit yoffederalwa y.crar
The ollowi • is -•uired in ormation-an inco •lete a••lication will not be acce•ted. Please •rint le•ibl in ink)or • .
PROPERTY INFORMATION
SITE ADDRESS 27 = — Pacific Highway South SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT o BUILDING ❑ PLUMBING ❑ MECHANICAL
o DEMOLITION iv ELECTRICAL o ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
Install new fire alarm system.
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PROJECT NAME(Name of Business or Owner Last Name Hollywood Video Store
PEOPLE INFORMATION
PROPERTY NAMEi PRIMARY PHONE
OWNER
MAI NG DR S CI TATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Fire Corn NW LLC Jeff Dunlap (206)234-5700
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
PO Box 3932 Seattle WA 98124 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20-04-101817-00-BL 12/31/05 (206)244-1957
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Fire Com NW LLC Jeff Dunlap 206-234-5700
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
PO Box 3932 Seattle WA 98124 ( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑ Tenant 0 Agent X Other(Describe) Contractor (206)244-1957
CONTACT NAME (206)234-5700 jeffdunlapl@aol.com
Jeff Dunlap
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE Retail Store
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $7,500.00
SPRINKLERED BUILDING? YES X NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST 5,605 5,605
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**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.
MECIIAIVICAL
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(Toilet) 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 filed against the City of Federal Way,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.
NAME/TITLE2 DATE Z 2g—0
igna ure) s'44 ------1)\C\ (Title)
RELATIONSHIP TO PR ❑ Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑NEW a ADDITION a ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES a NO DEMO PERMIT REQUIRED? a YES ❑NO