16-100365elve® 0
SAN 2 206 PERMIT APPLICATION
Federal Way I OF FED�Rp,L W A
C CDs i
PERIIIIT NUMBER r _ �J e� y5 L
1
— TARGET DATE i
SITE ADDRESS SUITE/UNIT 9
L L C
PROj1%CT VALUATION .
ZONING
ASONSSOR'S TAX /PARCEL.
$ 20,520.00
. -02104 -9035_
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
Mirror Lake Elementary School Portables
Add fire alarm sistem to 2 new, portable classrooms. Will tie, in to
PROJECT DESCRIPTION
Detailed description of work to
re Alarm system,
be included on this permit only
I1A*E Federal Way School: District
TT94'9v55938
PROPERTY OWNER
NUUL to ADDRESS
E-WAIL
33330 8th Ave S.
CITY
Federal Way
"ATE
WA
ZIP
98003
'
NAM PK Electric
206 - .230 -9100
NAMING ADDRESS
F WAIL
..CONTRACTOR
7834 SF
-ZIP
CITY
-
STATE
... ... ..
FAX
...
-
M r - . ,
WA
98.040.
WA STATE CONTRACTOR'S LICENSE f
'B]ommon DATE.
FEDERAL WAY mush m LICENSE 1
.
PKELE**2Z2BT
2 /3 17
602245692
N SimplexGrinnell
P 206 -291 -1400
NAMING ADDRESS
9520 10th Ave. S. Suite 100 iaStE
E-MAU.
bbins sim lex rinnell.
APPLICANT
csTr
STATa
ZIP
FAX
Seattle
WA
98108
206 - 291 -1500
PROJECT CONTACT
NAME SimplexGrinnell /Janet Stebbins .
P�-MT 1468 .
XAMINGADDRESS
9520 1pth Ave S. Suite 100 'ast
zaL* .
bbins sim lex rinnell.
Mw individual to receive and
respond to all correspondence
CITY
STATE
zlp
'
conceming this application)
Seattle
WA
98108
2
206 - 291 -1500
PROJECT FINANCING
NAM
❑ OWNER- FINANCED
When atue is $5,000 or more
NAMING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I cert{fI under penalty of perjury that I am the property owner or authorized agent of the property owner. I certi* that to the best
of fry knowledge, the information submitted in support of this permit application is tree and correct. I certijj that I will comply with
all applicable City of Pbderal 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 environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim finoluding oosts, expenses, and attoragW fees incurred in
the investigation and defense of such otairriA, which may be wade 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 offteers and emptoyces, upon the accuracy of the
information supplied to the city as apart of this. application.
SIONATURE: Ott DATE 1/15/2016
�aned
PRINT NAME: ir
Stebbins for SirnplexGrinnell
Bulletin ti 100 – December 29, 2015 Page 1 of 3 k:1 lmdoutsTermit Application