20-104580-CO Bldg. permit app_11.18.20DocuSign Envelope ID: 5F9A2B9A-B4A3-4930-89AF-6D3972ADA2FC
CITY OF X
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenteiCacitz olrederalxva:-.conl
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
2000-222 S.324th St., suite #2104, Federal Way, WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$9000.00
CC-F
0921049053
TYPE OF PERMIT
X BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Yo Soy Unico Daycare, existing kitchen remodel in Hillside Plaza Shopping Center
PROJECT DESCRIPTION
Detailed description of work to
Approx. 73 sq. ft
be included on this permit only
NAME
PRIMARY PHONE
Hillside Plaza Associates LLC C/O Rosen HarbotUe CRE
425-289-2231
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
PO Box 5003
jeaafferg')rosenh=bottlexom
CITY
STATE
ZIP
Bellevue
WA
98009-5003
NAME
PHONE
C 8s N Contractor
(253)359-0058
MAILING ADDRESS
E-MAIL
CONTRACTOR
6018 S. Cheyenne St.
CITY
STATE
ZIP
FAX
Tacoma
WA
98409
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
CC CNCONC*8420A
9-1-2021
604-030-890
NAME
PRIMARY PHONE
RODDY J. NOLTEN, P.E.
(253) 874-9323
APPLICANT
MAILING ADDRESS
1220 S. 356th Street, suite A3
E-MAIL
rnol10@rjnconsultants.com
CITY
STATE
ZIP
FAX
FW
WA
I
98003
NAME
PRIMARY PHONE
PROJECT CONTACT
RODDYJ. NOLTEN — SEE UNDER APPLICANT
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
NAME
PROJECT FINANCING
YO SOY UNCO, DAYCARE, CARMENCORBIN
OWNER -FINANCED
When value is SS,000 or more
(RCW 19.2Z 095)
MAILING ADDRESS, CITY, STATE, ZIP
2000-222 S.314th Str., suite #2104
PHONE
(253) 2698838
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 may 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 apart of this application.
Bulletin i* 100 - February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
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DocuSign Envelope ID: 5F9A2B9A-B4A3-4930-B9AF-6D3972ADA2FC
Dmu5igned by:
SIGNATURE'
PRINT NAME:
11/10/2020
Bulletin #100—February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application
DocuSign Envelope ID: 5F9A2B9A-B4A3-4930-B9AF-6D3972ADA2FC
MECHANICAL PERMIT
Indicate how many, j of each tyP<
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
to be installed or relocated as
FANS
FIREPLACE INSERTS _
FURNACES
GAS LOG SETS _
GAS PIPING
VALUE OF MECHANICAL WORK
f this project Do not include existing fixtures to remain
GAS PIPE OUTLETS OTHER (Describe)
HOODS (co—e jd)
HOT WATER TANKS (G—)
REFRIGERATION SYST
WOODSTOVES
PLUMBING PERMIT
Indicate how many of each type of
udure to be installed or relocated as
part o this project Do not in
BATHTUBS (or Tub/Show c—bo)
LAVS (H—dSinka)
TOILETS
DISHWASHERS
RAINWATER SYSTEMS
URINALS
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (r#chea/utait3.)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
VALUE OFPLUMBING WORK
dude existing flxtures to remain.
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
OF EMS IMPROVEMENTS
IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
�VALUE
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DES ION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals EXISTING PROPOSED TOTAL
�RJVEw HOIMs OxLY*x
SELLING PRICE
# OF BEDROOMS
FOR OFFICE USE
COMMERCIA — EW/ADDITION
AREA DESCRIPTION
S uare Feet
Occupancy Group(s) )4
Cons1truection
# of
Additional Information
NEW BUULDING
AD
COMMERCIAL— REMODEL/TENANT IMPROVEMENTS KO-CKv -1
AREA DESCRIPTION:::
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL, BUILDING
TENANT AREA ONLY
PRojECT AREA ONLY
�I
V M
Bulletin 9 100 — February 19, 2020 Paae 3 of 2 k:\Handouts\Permit Application