04-102494 iiiiik
away PERMIT
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04 - 102494
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP
33530 FIRST WAY SOUTH•PO BOX 9718 APPLICATION
FEDERAL WAY,WA 63-9718 TO 0 7 / 14 /04
253-661-4115•FAX 253-53-661-4129
www.cihpffederalwan.corn
The ollowin• is re.uired in ormation-an incom.lete a.•lication will not be acce•ted. Please •rint le•ibl (in ink)or .e.
• PROPERTY INFORMATION
SITE ADDRESS 28855 Military Road South SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descnptton)
• PROJECT INFORMATION
TYPE OF PERMIT TSJ\BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
Installation of backroom storage shelving/racking
PROJECT NAME(Name of Business or Owner Last Name) Walgreen #6901
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Walgreen Co. ( 847 ) 914 - 3314
MAILING ADDRESS CITY,STATE,ZIP
200 Wilmot Road Deerfield, IL 60015
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
TriWay Cosntruction Ray Allard (253) 735 - 2211
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1302 West Main Street, Ste 35 Auburn, WA 98001 (253) 261 - 2072
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
''."-^-.-..'f, — — - B L / / ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
-N,_. . / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Contractor ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect 0 Tenant 0 Agent ❑ Other (Describe)_ ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
Ray Allard (253) 735 - 2211 rav(altriwayconst.com
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1,000
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EEISTDIO SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not Include,,. existing fixtures_,..
to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commerdet) W OODSTOV ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS ) (Describe)
(Toilet) MISC Describe
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) _ VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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.
NAME/TITLE GIC 5lb __ . DATE 7. LZ •D
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
❑ NEW o ADDITION ❑ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? a YES ❑NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? ❑YES ❑NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application
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Federal Way =E$ - -k-Q- ( `7
PERMIT SF MF Co M' DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•1'O BOX 9718 2 3 2AAP P L I C AT I O N
FEDERAL WAY, 98063-9718 J U)� kp / I cf
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253-661tr,4115•FAXX 253b614]29 I {�
ww .dtUo/federdmm /(TJl
waU�
CITY F F - -
The ollowin. is re•ui:4 S t qua: ' :19 Wailnco .lete a..iication will not be acce.ted. Please .rint le.ibl (in ink)or .-.
�, PROPERTY INFORMATION •
SITE ADDRESS Za's `^`_l 1"1 i'd•{lr'Y F-` Soar--I SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE (sf7
LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal desoipion)
. - PROJECT INFORMATION
TYPE OF PERMIT legUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlq)
i tN,15T.e1..)..i•. .4,TLb,r-! c51= • c - -j5"Ia -•C' .H ELVI N-1 U�j;Acic4AIe1
PROJECT NAME(Name of Business or Owner Last Name) A.A.I..e=iLEE17.-( 44 (p9 O 1
• PEOPLE INFORMATION •
",, •ROPERTY NAME / PRIMARY PHONE
OWNER ) 4.l.64z,b.) G_.O . (8't-7) 914.3 r•
MAILING ADDRESS CITY,STATE,ZIP
71:t2v W 1.1.4.1 3r . e:Vp �_eri E Lc.) =L. . (...Q d?S.-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
-Tux ti✓h'y Coos i iz►x ricAD ioyA1/4.1-1-•d,. 'i (ZSR)73S -ZZ! 1
MAILING ADDRESS CITE STATE,ZIP CELL PHONE
1 3c .1Oesr {MAJA.)Sr)) S1...,L-rE143s Ave,L4-47.4/ WA. 99tm 1 (2S3) ae.i -2 7Z,
CITY OF FEDERAL WAY BUSINESS LICtNSE NUMBER EXPIRATION DATE FAX NUMBER
_ B L / / ( ) _
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME //�� APPLICANT NAME OFFICE PHONE
///'''������
MAILING ADDRESS ( )
CITY,STATE,ZIP
CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other (Describe) ( )
CONTACT NAME
PRIMARY PHONE E-MAIL ADDRESS
„'
ALL (Z63j 73s -2Zt 1 pAi'`.iru&Ay44R.tsr•TAs*1
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
- DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED ORK $ /OM
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQ -.- :- ■ It ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 1
111 PRIVATE(SEPTIC)
I
•
PROJECT FLOOR AREAS .
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
e=.7.1
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED _
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS 'EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(roaeq MISC(Describe)
DISHWASHERS SINKS DRIVING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES _ URINALS HOSE BIBBS
LAYS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,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.
—Th
NAME/TITLE V t.,E Ips_ DATE Co' Z3-c5c4
(Signature) (Title)
RELATIONSHI 0 PROJECT 0 Owner o Agent erEontractor 0 Architect ❑ Other
FOR OFFICE USE ONLY
o NEW a ADDITION o ALTERATION_ o REPAIR ❑TENANT IMPROVEMMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES ❑NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application