10-101744 CITY OF` • — O 7-4--4
Federal Way PERMIT .7
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN/F I.. '
3332 FEDERAL WE,WA 9•POBOX 9718 8 APPLICATION 'U RE EIVE p
FEDERAL WAY,WA 98063-9718
k 253-835-2607•FAX 253-835-2609
uJIDlu.ciCyoflederalu)ay.cont
The following is required information-an incomplete application will not be accepted. Plea*aRit9J£aikQ(in ink)or type.
IN PROPERTY INFORMATION
• • p A 11
SITE ADDRESS_34515 9th Ave South stialysNIT#
ASSESSOR'S TAX/PARCEL# 7 5 0 4 5 1 - 0 0 2 0 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 ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING❑✓ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
Add and relocate fire sprinkler heads for tenant modifications.
PROJECT NAME(Name of Business or Owner Last Name)
IIIA PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Patriot Fire Protection, Inc. Clint Carr ( 253 ) 926 - 2290
Q' MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
2707 - 70th Ave E Tacoma, WA 98424 ( )
/ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
19-91-101988-00-BL 12-31-08 ( 253 ) 922 - 6150
04CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
PATRIFP099CF 10-5-10
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Patriot Fire Protection, Inc. Clint Carr ( 253 ) 926 - 2290
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
2707 70th Ave East Tacoma, WA 98424 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ather Subcontractor (253 ) 922 - 6150
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Clint Carr ( 253 ) 926 - 2290 clintc@patriotfire.com
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE Hospital PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ $2,300.00
SPRINKLERED BUILDING? ❑� YES 0NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?❑YES ONO
WATER SERVICE PROVIDER LAKEHAVEN _HIGHLINE TACOMA PRIVATE(WELL)
SEWER SERVICE PROVIDER ELAKEHAVEN �HIGHLINE PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
,572
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED 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 WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(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(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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 application.
SIGNATURE: ' c=`� DATE 4-27-2010
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-January , 2008 Page 2 of 4 k\Handouts\Permit Application