HomeMy WebLinkAbout15-102109 COY OF G PERMIT APPLION 4,�
Federal Way MAY 04 2015 "71a�
9
PERMIT NUMBER ( :j _ ( 0 2 l _ `� C11'Y OF FEDERAL WAY
_ TARGET DATE CDS
- -
SITE ADDRESS SUITE/UNIT#
31517 PACIFIC HWY S, FEDERAL WAY, WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4507.00 Q _8_ _2__ _1_ Q _4_ - _9_ _1_ _8_ _1_
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING IX FIRE PREVENTION
NAME OF PROJECT TOYKO YA RAMEN HOUSE
PROJECT DESCRIPTION FIRE SPRINKLER T.I. (16 SPRINKLERS)
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER KIMCO REALTY CORP
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
EMERALD FIRE LLC 253-857-2056
MAILING ADDRESS E-MAIL
CONTRACTOR
11021 CRAMER RD KPN ANGIEVQEMERALDFIRELLC.COM
CITY STATE ZIP FAX
GIG HARBOR WA 98329 253-857-2312
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE II
EMERAFL980MR 7 i 19 / 16 20-14-11.04959-00-BL
NAME PRIMARY PHONE
EMERALD FIRE LLC 253-R57-205A
APPLICANT MAILING ADDRESSE-MAIL ANGIEV@EMERALDFIRELLC.COM
11021 CRAMER RD KPN
CITY STATE ZIP FAX
GIG HARBOR WA 98329 253-857-2312
NAME PRIMARY PHONE
PROJECT CONTACT KEITH HILLSTROM 253-857-2056
MAI(The individual to receive and LING ADDRESS E-MAILTHH@EMERALDFIRELLC
respond to all correspondence 11021 CIRAMER RD KPN
concerning this application) CITY STATE zi58329 FAX
GIQHARBOR _WA 253-857-2312
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$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 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 a part of this application.
SIGNATURE:9d ^ DOld-P4O-C.
DATE 28 APRIL 2015
PRINT NAME: ANGIE VOELPEL
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
