17-102832 RECEIVED
JUN 13 2017 PERMIT APPLICATION
CITY of 4A
Federal Way CITY OF FEDERAL WAY JJ trial,`' _2 3 �(,z2 ZZ
COMMUNITY DEVELOPMENT ,,
PERMIT NUMBER \ 1 _ /t 0 2- ' 3 2__ ? N P
TARGET DATE
SITE ADDRESS 33 ki go 13 p(. c
8SUITE/UNIT#
3148 20TH 8ve South Federal Way, WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3/ 070, o") 76 8 1 9 0 — 0 0 jEj 2
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING 11tFIRE PREVENTION
NAME OF PROJECT Telecare King County Evaluation & Treatment Center
Installing 176 Fire Sprinkler Heads
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
- „
NAME PRIMARY PHONE
PROPERTY OWNER TELECARE MENTAL HEALTH SERV
MAILING ADDRESS E-MAIL
33500 13TH PL S 98003
CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
Emerald Fire (253)857-2056
MAILING ADDRESS E-MAIL
11021 Cramer Road KPN angiev@emeraldfirellc com
CONTRACTOR
CITY STATE ZIP FAX
Gig Harbor WA 98329 253-857-2312
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
EMERAFL98OMR 07 / 19 / 2018 20-14-104959-00-BL
NAME PRIMARY PHONE
Emerald Fire / Keith Hillstrom (253) 857-2056
APPLICANT MAILING ADDRESS E-MAIL
11021 Cramer Road KPN
CITY STATE ZIP FAX
Gig Harbor WA 98329 253-857-2312
NAME PRIMARY PHONE
PROJECT CONTACT Keith Hillstrom 253-857-2056
(The individual to receive and MAILING ADDRESS E-MAIL
11021 Cramer Road KPN
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
Gig Harbor WA 98329 253-857-2312
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
IRCW 19.27.095)
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 he city as p rt of this application.
i/
SIGNATURE. t ti D .--(9, ATE 6-9-17
PRINTNAME: ingi, Voelpel
Bulletin#100—January 1,2013 Page 1 of 3 101-Iandouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
$
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commerc.at(
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or T n/shower combo( LAVS(Hama s nks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS Kitchen/Utility( WATER HEATERS(Eteetr,o
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT.
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
*new Nowa ONLY"'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2013 Page 2 of 3 k:AHandouts\Permit Application