18-102691 RECEIVED
'�... PERMIT APPLICATION
CITY OF ,.. :.,.........
Federal Way JUN 2 0 2018 PERMIT CENTER+33325 80,Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter(acityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER / F _ / D / _ ///
�l
✓✓✓111 lC� l� TARGET DATE
SITE ADDRESS SUITE/UNIT#
1520 S 348th Street&- +71-' '!th- S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 336,828.00 CE 8897000095 &8897000115
TYPE OF PERMIT M BUILDING ❑ PLUMBING ❑ MEcnANICAL E DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT Jacksons No. 636
Redevelopment of the Jacksons Convenience Store&Fuel Station.
PROJECT DESCRIPTION New 3812 sf convenience store,associated fuel station piping and site work.
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 sIDTE ZIP D 83642
NAME TBD PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
i
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 (425)251-6222
(The individual to receive and MAILING ADDRESS 18215 72nd Ave South E-MAIL
respond to all correspondence pitopper@barghausen.com
concerning this application) CITY Kent STATE ZIP FAx
WA 98032 (425)251-8782
NAME
PROJECT FINANCING I] 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 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 erwlrurunental 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 arty 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: /- i i' ! ~;, ) DATE June 15,2018
PRINT NAME: Jack Davis
U. __._.. _ ---
Bulletin
—Bulletin#100 -January 29,2016 Page I oft 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 for 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(Electric)
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
S
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 04 No ji Yes ad 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 0 CARPORT :-
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE S #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Construction # of
Occupancy Group(s) Additional Information
Square Feet Type Stories
NEW BUILDING 3812 M- Mercantile VB 1 Convenience Store
COMMERCIAL— REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Construction # of
Occupancy Group(s) Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT Asl A ONLY
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of k:W andouts\Permit Application
OD
Jocksons
RECEIVED
JUN 2 0 2018
0)
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT tl"
December 19, 2017
Subject: Barghausen Consulting Engineers, Inc.,
Predevelopment and Entitlements representative for the Jacksons Food Stores
Oregon and Washington
To Whom It May Concern:
Barghausen Consulting Engineers, Inc. located at 18215 72"Ave South Kent, WA 98032 has been
retained by Jacksons Food Stores, Inc. (and PacWest Energy, LLC dba Jacksons Food Stores)as a
consultant and representative for the purpose of designing, and obtaining all necessary permits for
reimaging, remodeling, and construction of our convenience stores and fueling centers for calendar year
2018. Their employees and agents are authorized to conduct meetings, submit applications, and
process related documents and submittals necessary to facilitate this process.
If you have any questions, concerns, or you require additional information, please feel free to contact
me via any of the methods listed below.
Best Regards,
at-7117)t.
Davis
Vice President of Facilities
Jacksons Food Stores, Inc.
3450 E. Commercial Court
Meridian, ID 83642
jack.davis@jacksons.com
Office: 208.888.6061
Cell: 208.841.0496 v w y y `•,,,,,,,,,,,,1 ��O
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RECEIVED
LakehavenFEAL
JUN 10 2018co
WATER &SEWER DISTRICT
COMCIUNf7 F y D�O MEM'
Lakehaven Water & Sewer District - Development Engineering Section
31623 - 1st Ave S • PO Box 4249 * Federal Way, WA 98063-4249
Telephone: 253-945-1581 or 253-945-1580 • Email: DE@Lakehaven.org !A
This certificate is intended to provide the applicant, land use agencies &/or public health departments with
information necessary to evaluate development proposals. Lakehaven Water & Sewer District, at its sole
discretion, reserves the right to delay, or deny, sewer service based upon capacity &/or supply limitations
in Lakehaven's or Other Purveyor's system facilities.
Proposed Land Use: ® Building Permit-SFR ❑ Building Permit-MFR ❑ Building Permit-Other
❑ Subdivision 0 Short Subdivision ❑ Binding Site Plan
❑ Rezone ® Boundary Line Adjustment
❑ Other(specify/describe)
Tax Parcel Number(s): 8897000095 &8897000115 Site Address: 34713-16th Ave S Lakehaven GIS Grid: 3-12
Ex. Bldg. Area to Remain: N/A sf New Bldg. Area Proposed: 3,594 sf Retail + 2,000 Acc. Storage
Applicant's Name: Jacksons Food Stores
SEWER SYSTEM INFORMATION
1. ® Sewer service can be provided by service connection to an existing 8"or 12"diameter sewer main that is
approximately 10+/- feet from the site and the sewer system has the capacity to serve the proposed land use.
2. 0 Sewer service for the site will require an improvement to Lakehaven's sanitary sewer system of:
❑ a. feet of "diameter sewer main or trunk to reach the site; and/or
❑ b. The construction of a sanitary sewer collection system on the site; and/or
O c. A major portion of Lakehaven's comprehensive wastewater system plan would need to be implemented and/or
constructed; and/or
❑ d. Other(describe):
3. ® a. The existing sewer system is in conformance with Lakehaven's Comprehensive Wastewater System Plan.
0 b. The existing sewer system is not in conformance with Lakehaven's Comprehensive Wastewater System Plan and an
Amendment to this Plan will be required. This may cause a delay in issuance of land use approvals or permits.
4. ® a. The proposed site land use is within the corporate limits of Lakehaven Water&Sewer District, or has been granted
Boundary Review Board approval for extension of sewer service outside of Lakehaven's sewer service area.
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
5. Sewer service is subject to:
® a. Payment of connection charges (to be determined by Lakehaven, for any new/modified service connection);
❑ b. Proof or reservation of easement(s) as required by Lakehaven;
• c. Other: Sewer Service Connection Permit required, for anv new/modified service connection.
Comments/special conditions:
I hereby certify that the above sewer system information is true. This certification shall be valid for one (1) year from the date of
signature.
Name: BRIAN ASBURY Title: DEVELOPMENT ENGINEERING SUPERVISOR
Signature: >/ v. /4 . ..w`_ Date: 15/i, / i
8897000095 8897000115 swr.docx (Form Update 1/3/17) Page 1 of 2
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fiDTE: Lakehaven lPJater and Se er Sewer C ertificate of Availability
District neither r.arrants nor guarantees Parcels 8897000095 & 8897000/15
the accuracy of any facility information 1:3:
provided. Facility locations and conditions
are subject to field verification. MENINIM
',sit. $114'2017 BLa.
8897000095 8897000115 swr.docx (Form Update 1/3/17) Page 2 of 2
11Lakehaven RECEIVED
1) WATER&SEWER DISTRICT1.61
JUN 2 0
2018 co
immiumimmommmitCITY OF FEDERAL WAY
MMUNCTY DEVELOPMENT ..a
Lakehaven Water & Sewer District - Development Engineering Section
Co
31623 - 1st Ave S • PO Box 4249 * Federal Way, WA 98063-4249
Telephone: 253-945-1581 or 253-945-1580 * Email: DE@Lakehaven.org N
This certificate is intended to provide the applicant, land use agencies &/or public health departments with co
information necessary to evaluate development proposals. Lakehaven Water & Sewer District, at its sole
discretion, reserves the right to delay, or deny, water service based upon capacity &/or supply limitations
in Lakehaven's or Other Purveyor's system facilities. a '�
Proposed Land Use: E Building Permit-SFR ❑ Building Permit-MFR ❑ Building Permit-Other
❑ Subdivision ❑ Short Subdivision 0 Binding Site Plan
❑ Rezone E Boundary Line Adjustment
❑ Other(specify/describe)
Tax Parcel Number(s): 8897000095 &8897000115 Site Address: 34713-16th Ave S Lakehaven GIS Grid: J-12
Ex. Bldg. Area to Remain: N/A sf New Bldg. Area Proposed: 3,594 sf Retail + 2,000 Acc. Storage
Applicant's Name: Jacksons Food Stores
WATER SYSTEM INFORMATION
1. E Water service can be provided by service connection to an existing 8", 10"or 12"diameter water main that is approximately
10+/-feet from the site.
2. E If additional/onsite fire hydrant(s) required, water service for the site will require an improvement to Lakehaven's water
distribution system of:
E a. 10+/- feet of 8"or 12"diameter water main to reach the site; and/or
E b. The construction of a water distribution system on the site; and/or
O c. A major portion of Lakehaven's comprehensive water system plan would need to be implemented and/or
constructed; and/or
• d. Other(describe): Lakehaven Developer Extension Agreement required.
3. E a. The existing water system is in conformance with Lakehaven's Comprehensive Water System Plan.
❑ b. The existing water system is not in conformance with Lakehaven's Comprehensive Water System Plan and an
Amendment to this Plan will be required. This may cause a delay in issuance of land use approvals or permits.
4. E a. The subject property is within the corporate limits of Lakehaven Water&Sewer District, or has been granted
Boundary Review Board approval for extension of water service outside of Lakehaven's water service area.
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
5. Water service is subject to:
E a. Payment of connection charges (to be determined by Lakehaven, for any new/modified service connection);
❑ b. Proof or reservation of easement(s) as required by Lakehaven;
• c. Other: Water Service Connection application(s) required, for any new/modified service connection(s).
Comments/special conditions: The existing meters (2, domestic) for the site need to be evaluated under UPC & Lakehaven
standards, to determine if they're adequate for the proposed uses. Service pressure(s) greater than 80 psi indicated, Pressure
Reducing Valve(s) indicated, contact local building official for requirements&/or additional information.
The nearest fire hydrant is approximately 5+/- feet from the Property (as marked on map on the back of this page).
Fire Flow at no less than 20 psi available within the water distribution system is 2,500 GPM (approximate) for two (2) hours or more.
This flow figure depicts the theoretical performance of the water distribution system under high demand conditions. Fire flow rates
greater than this may be accommodated through water distribution system improvements, contact Lakehaven for additional
information.
538 Pressure Zone Est. Meter Elevations-GIS: High 284+/-, Low 279+/- Est. Pressure Range at Meters (psi): 101-112
I hereby certify that the above water system information is true. This certification shall be valid for one (1) year from the date of
signature.
Name: BRIAN ASBURY Title: DEVELOPMENT ENGINEERING SUPERVISOR
Signature: -- Date: S tth
7
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fJOTE: Lakehaven Water and Seger Water Certificate of Availability
District neither warrants nor guarantees Parcels 8897000095 & 8897000115
the accuracy of any facility information53 13
' S
provided. Facility locations and conditions
are subject to f ie Id verif ication.
Fef $114'2017 E1A
8897000095 8897000115 wtr.docx (Form Update 1/3/17) Page 2 of 2