19-100456A CITY OFz
Federal Wav
p5051 ED PERMIT APPLICATION
JAN 2 $ 2� 1 PERMIT CENTER + 33325 8'h Avenue South + Federal Way, 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(Dcityoffederalway.com
CITY OF FEDERAL WAY
CWMUN" DEVE/�//LIOPM)))KiEPERMIT NUMBER —q _ 1-0 ill/// / 1� � 5— 6 _
TARGET DATE
SITE ADDRESS
SUITE/UNIT#
32290 First Ave S
Level 1
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL#
$ 20,000
_ _ _ 1721049039 _
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING M FIRE PREVENTION
NAME OF PROJECT
Brookdale Foundation House
ADD / RELOCATE 62 SPRINKLERS FOR RETIREMENT HOME REMODEL REVS TO WALLS AND CEILINGS.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
Brookdale Foundation House
615-564-5143
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
111 Westwood PI, Ste 400
CITY
STATE
ZIP
Brentwood
TN
37027
NAME
PHONE
FIRE SYSTEMS WEST
253-833-1248
MAILING ADDRESS
E-MAIL
CONTRACTOR
206 FRONTAGE RD N, SUITE C
THEROND@FIRESYSTEMSWEST.COM
CITY
STATE
ZIP
FAX
PACIFIC
WA
98047
253-735-0113
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
FIRESWI 140B1
12 31 2019
19 -87 -000014 -00 -BL
NAME
PRIMARY PHONE
FIRE SYSTEMS WEST
253-833-1248
APPLICANT
MAILING ADDRESS
206 FRONTAGE RD N, SUITE C
EMAIL
CITY
STATE
ZIP
FAX
PACIFIC
WA
98047
253-735-0113
NAME
PRIMARY PHONE
PROJECT CONTACT
THERON DAVIS
253-833-1248
MAILING ADDRESS
206 FRONTAGE RD N, SUITE C
E-MAIL
THEROND@FIRESYSTEMSWEST.COM
(The individual to receive and
respond to all correspondence
CITY
PACIFIC
STATE
I WA
ZIP
98047
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 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 authorised 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 ofFeral Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), wh h may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the fiance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as apart of tltfs application.
SIGNATURE: IE �dp DATE 1 Lf�
PRINT NAME: THERON DAVIS
Bulletin #100 — January 29, 2016 r Page] of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT Is
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 (commemiai)
BOILERS FURNACES HOT WATER TANKS (ca9
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT Is
Indicate how many o each type offixture
to be installed or relocated as
part o this project. Do not include existing fixtures to remain.
BATHTUBS (orTub/Shower Combo)
LAVS (HandSinke)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utihty)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
Additional Information
NEW BUILDING
EXISTING/ PREVIOUS USE
LOT SIZE (In Squue Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
/Yes E No
E Yes -! No
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEUTENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING ..
) L1 ?, Ct
,1(ciS i �j �j �; l..,l �{ I N C.I
v
! j
TENANT AILEA ONLY
PROJECT AREA ONLY
. q'�. z"r
r 1 `
V
I
Bulletin # 100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application