08-103527 •
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, Federal Way JUL 2 4 z006 PERMIT 0)
COMMUNITY DEVELOPMENT SERVICES
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SOUTH•PO
OX 9718
333 253835V 2607E,FAX 53832 809 Ct 1 OF FEDALI CATION TD
FEDERAL WAY,WA 980639718 / /
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS_ 33702 21st Avenue S.W. SUITE/UNIT#,
ASSESSOR'S TAX/PARCEL# 9 3 0 1 0 0 - 0 0 1 0 LOT SIZE(sJ) 675,858
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1 Westlake, lot 1, King County
(Attach separate page for lengthy legal descaptioN
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
construction of a Fred Meyer fueling facility; includes installation of five (5) multi-product
dispensers, two (2) underground gasoline storage tanks: one (1) 20,000 gallon and one (1)
16,000 gallon dual (8,000/8,000 gallons for unleaded and diesel fuels) with associated underground
piping and equipment monitoring systems
PROJECT NAME(Name of Business or Owner Last Name) FRED MEYER GASOLINE FACILITY
• PEOPLE INFORMATION
PROPERTY NAME FRED MEYER STORES, INC. PRIMARY PHONE
OWNER/LESSEE ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
3800 SE 22ND AVENUE PORTLAND, OR 97202
CONTRACTOR COMPANY NAME J APPL ANT NAME 1 OFFICE PHONE
TO BE DETERMINED -...„ C ) ,4-'I LC/:�l ' k,1.,J Ker h,�z I ( ,'.S3 ) 9„2A - E'S C-,4 S
MAILING ADDRESSC STATE,3L IP CELL PHONE
/ 3( 7 SYS /34C L- }C 1t.:A `ig9.2.q ( 5.$) Zoe: - 1711;25
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
C ,LICL 0 .26 (St' i) C).2-2'" 721-',-6
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
'-CLtLHc Iii ::7%l..7-- .3/I//r, 1-1,, 0'Jccia,Alt 0C(0r+
APPLICANT COMPANY NAME FRED MEYER C/O APPLICANT NAME OFFICE PHONE
BARGHAUSEN CONS. ENGRS. JOEL HOWITT (425 ) 251 - 6222
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
18215 72ND AVENUE SOUTH KENT, WA 98032 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
R Architect ❑Tenant XAgent X Other ENGINEER (425 )251 _ 8782
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT JOEL HOWITT ( 425 ) 656 1073 jhowitt@barghausen.com
LENDER NAME Per RCW 19.27.095:
owner financed Lender information is required if project value exceeds$5,000
MAILING ADDRESS Cr1Y,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE FRED MEYER RETAIL STORE PARKING AREA PROPOSED USE FRED MEYER RETAIL FUELING FACILITY
EXISTING ASSESSED/APPRAISED VALUE$ +/ 19,0 0 0,0 0 0 VALUE OF PROPOSED WORK $ 36,000.00
SPRINKLERED BUILDING? ❑ YES X NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES X NO
WATER SERVICE PROVIDER XLAKEHAVEN ❑ HIGHLINE ❑ TACOMA n PRIVATE(WELL)
SEWER SERVICE PROVIDER X LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
•.
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST 195,246 3,956 (canopy under
separate permit) 199,202
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL COSTING Sr TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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)
1 AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commerard)
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 ,••lication.
SIGNATURE: -/_/, , .1� ,irt DATE °7/�%
' operty• .'er and/or Authorized Agent
jor
FOR OFFICE USE ONLY
o NEW c ADDITION c ALTERATION c REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES o NO BASIC PLAN? n YES c NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? c YES c NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? c YES c NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application