18-102694 RECEIVED
`► PERMIT APPLICATION
CITY OF JIM 2 U 2018
Federal Way
OF'vPERMIT CENTER+33325 80'Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 + perrmtcenter(acityoffederalway.com
U
COMNRY DEVELOPMENTFEDERAL
PERMIT NUMBER /y __ / Q 6 / y _ G G TARGET DATE
SITE ADDRESS UVll//// SUITE/UNIT#
1520 S 348th Street&34713 S 16th Ave S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 87,510.00 CE 8897000095 &8897000115
TYPE OF PERMIT ® BUILDING ❑ PLUMBING ❑ MECHANICAL D DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT Jacksons No. 636
Redevelopment of the Jacksons Convenience Store&Fuel Station.
PROJECT DESCRIPTION New 3,486 sf fuel station canopy over 12 MPDs.
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
Jack Davis - Pac West Energy LLC (208)888-6061
PROPERTY OWNER MAILING ADDRESS E-MAIL
3450 East Commercial Court jack.davis@jacksons.com
CITY Meridian STATEIE ZIP 83642
NAME TBD PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
Barghausen Consulting Engineers,Inc. (425)251-6222
APPLICANT MAILING ADDRESS E-MAIL
18215 72nd Ave South
CITY STATE ZIP FAX
Kent WA 98032
NAME Pat Hopper,Barghausen Consulting Engineers,Inc. PRIMARY PHONE
PROJECT CONTACT C (425)251-6222
(The individual to receive and MAILING ADDRESS 18215 Ave South E-MAIL
respond to all correspondence 72nd phopper@barghausen.com
concerning this application) CITY Kent STATE ZIP FAX
WA 98032 (425)251-8782
NAME
PROJECT FINANCINGX❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
IRCW 19.27.09.5)
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
cunstraction 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: -
r ( if-1 DATE lune 15,2018
ck Davis
PRINT NAME: ______
Bulletin#100-January 29,2016 Page 1 of2 k: Handouts Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL 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.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial)
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 Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Elecvic)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Yes Lakehaven W&S District Lakehaven W&S District 665,000
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Vehicle Service Station 23,721 &21,949 SF Yes x No Yes x 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 i_: CARPORT C
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ - #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area mConstruction # of
Occupancy Group(s) Additional Information
_ Square Feet Type Stories
NEW BUILDING 3486 M-Mercantile IIB 1 Fuel Canopy
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100--January 29,2016 Pagc 2 of 2 0 Handouts PCrntit Application