03-100828 '� � � EIVED
; ,,,, CONSTRU(., �ON PERMIT APPLICATION
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� �°���� ` ,_ ' ` , PPLICATIOIV NUMBEFt:
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CITY OF FEDER WAY PP���ON NUMBER:
BUILDING DEPT. PPLICATION N'UMB�R: _ _'� . -
**The following is required information-please print(in ink)or type**
Please note: Electrical,Fire Preverrtion S�stems and Engineering permits may require a separate application.
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SITE ADDRESS: 34509 9di Avenae Sor�/y Suiifaee 110 (Bt�%/ding Permit#02-105370-00-CO)
ASSESSOR'S TAX/PARCEL#: 750451'OO�O
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• • • • •
TYPE OF PRO7ECT(Thf�application): o BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLIiION
❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
Ci�NFt'K e'�vt Er�Gc/1 sC�soe.y
PRO]ECT DESCRIPTION(Provide detailed description):Add and relocat�e sprinAdeis fn�new
�side of the bui/di A//ex�ssti �������r��
����* ng, ng sprinkleis shaNbe rep/acied witli quick response type sprink/eis.
PRO7ECT NAME: St, F�ancis Medica/O�cie Bui/dino Confe�ence/C/assroom
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PROPERTY OWNER: �ME� DAYfIME PHONE:
Franciscan Health Svstem (253) 591-6835
MAILiNG ADDRESS(57REET ADDRESS;CI'TY,STAIE,ZIP):
1717 South J Stree�,Tacoma WA 98405
CONTRACTOR: NAME: DAYTlME PHONE:
Fire Svstems west (253) 833-1248
MAILING ADDRESS(STREEC ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
219 Frontage Road North,Suite B; Pacific,WA 98047 (253) 833-1248
CITY OF FEDERAL WAY BUSINESS LiCENSE NUMBER; FAX NUMBER:
19-87-000014-00-BL (253) 735-0113
CONTR,4CTOR5 REGISTRATION NUMBER: DCPIRATION DATE:
(�oP�or�ro.equire� FIRESWI14061 10/03/03
APPLICANT: N�E� DAYTIME PHONE:
Paul G.Boze (253) 833-1248
MAILTNG ADDRE55(S"fREET ADDRESS;CITY,STATE.ZIP): EVENING PHONE:
219 Frontage Road North,Suibe B;Pacific,WA 98047 (253)833-1248
RELATIONSHIP TO PRQIECT: FAX NUMBER:
❑ARCHITECT ❑TENANT X OTHER(DESCRIBE):Project Designer (253) 833-1248
E-MAIL ADDRE55:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER X APPLICANT ❑CONTRACTOR �ulb�firesysCemswest.00m
• • • • •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: �2,881.00
SPRINKLERED BUILDING? X YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAI�HAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: �
• • • • �
FLOOR DQSI'ING .FT. PROPOSED .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each t�rpe of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELEGTRIC ❑ GAS
PLUMBING
BATtiTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
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I certify under penalty of perjury that the information furnished by me is true and correct to tl�e 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 t�hold harmless the City of Federal Way as bo 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 art 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: �L���/,/_ _1(?7L p.�rl�if— ,[,CQ�G�.,� DATE: 2/27/03
r
❑ PROPERTY OWNER ❑APPLICANT X OONTRACTOR
FCJR Q�FIC�U5E ONIY:
o NEW o AQDITiON ❑ALTERATION ❑ REPAIR ❑TENANT IMPROYEMENT
CENSUS'C�DE: LOT SIZE:
ZONING DESIGNATION: SUILDII�tG SHELL'ON�.Y? ❑1(ES a NO
COMP PLAN�ESIGNATION BASIC PLAN? ❑YES ' o NQ
SECTION TOWNSHIP RANGE NEW ADQRfSS RE UIEtED? ❑YES ❑ NO
RLATFED'LOT? ❑YES ❑ NO CHANGE�F USE? ' ❑YES � NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661�000•FAX:253-661-4129
www.cityoffiederalway.com