13-105512 1
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Federal way DEC 11 2 PERMIT
COMMUNITYDEVELOPMENT SERVICES
SF MF CO ME EL PL DE E FP
33325 8�AVENUE,WA 9•POB iA 'LI CATI O N /1
FEDERAL WAY,WA 98063-9�®F F�D E To
253-835-2607•FAX 253-835-2609 CDS
www.citponederatwaq.com
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 505 336th St. IeQL..- SUITE/UNIT#_
ASSESSOR'S TAX/PARCEL it 9264800270 __ __ LOT SIZE(s,f)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Atm`sP@utEP.9.Ia'Iergthy 1.9.1 drertiptloN
IN PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING )I FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
Add or relocate 17 sprinklers for a new floor layout
NO(old Com muulr 'e s
PROJECT NAME(Name of Business or Owner Last Name)
• PEOPLE INFORMATION
PROPERTY NAME FSP FEDERAL WAY CORP PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Evergreen Fire Protection Mike Hutchinson ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
CnY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
20-05-106411-OOBL ( ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
Evergfp967Iz 12/12
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Evergreen Fire Protection Mike Hutchinson (253 ) 848-0146
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
10509 64th Ave.E. Puyallup 98373 ( 253 ) 381 _ 4456
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant o Agent o Other ( 253 ) 848 - 0965
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Mike Hutchinson (253 ) 381 _ 4456 Evergreenfirepro@msn.com
LENDER NAME Per RCW I9.27.095:
Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE Office space PROPOSED USE Office space
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 2200.00
SPRINKLERED BUILDING? Xl YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
,w
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR LI UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS 550 09ID TOTAL TOTAL sXESt1NGSF TOTAL PROPOSED sF TOTAL sr
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type offixture 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 rub/Shaver combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS crouet)
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:
. AA.,‘" fit' DATE 12/10/2013
operty Own and/or Authorized Agent
FOR OFFICE USE ONLY
o 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 1,2008 Page 2 of 4 k\llandouts\Permit Application