10-104044C!YV " A--
Federal Way
COMMUNITY DEVELOPMENT SERVICES
25.1. 83.5.2607- FAX 253 -835 -2609
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OPERMIT R EC F CO ME PL DE EN FP
APPLICATION D
SEP 2 3 20 if, � An
C1
7-Y
SITE ADDRESS RA
::77CD7S wA
8SUITE /UNIT # IV
'
1010 SOUTH 336TH STREET
120
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL M
$ 3,500
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ENGINEERING PYRE
NAME OF PROJECT
,PREVENTION
SP�N+c MR SAM ,� �► r Q pe-TP
rrenant Name/HomeownerLast Name)
u/'�+l i-�
PROJECT DESCRIPTION
Detailed description of work to
1f =
be included on this permit only
NAME
PRDIARY PDO NE
PROPERTY OWNER
OMNI PROPERTIES INC
MAILING ADDRESS
E-MAIL,
CI1R
STATE
ZIP
PNONE
NAME
Patriot Fire Protection
253 - 926 -2290
MAILING ADDRESS
2707 70th Ave E
-
CONTRACTOR
CITY
zip
FAx
Tacoma .
WA
98424
253- 922 -6150
WA STATE CONTRACTOR'S LICENSE #
EIaIRATION DATE
FEDERAL WAT NOSINESS LICENSE •
PATRIFP099CF
10 /5 /
19- 91- 101988 -00 -BL
NAME
Plies 253- 926 -2290
Patriot Fire Protection
MAILING ADDRESS
2707 70th Ave E
E-MAD.
APMCAAT`
CITY
Tacoma
STATE
WA
21p
98424
FAX
253- 922 -6150
PROJECT CONTACT
CHRIS SEAMAN
pNONa 253.284.3401
individual to receive and
��I
respond to all correspondence
WAILING ADDRESS
2707 70TH AVE E
CHRISS @PATRIOTFIRE.COM
concerning this application)
CITY
TACOMA
STA
WAS
i>p 98424
FAx 253.284.3402
ALTERNATE CONTACT NAME;
JOHN DACCA
PNONE
253.926.2290
E-MAII,
JOHND@PATRIOTFIRE.COM
-
PROJECT FINANCING
NAME
❑ OWNER- FINANCED
Required value of $5, 000 or more
(RC W 19.27.095)
MAILING ADDRESS, CITY, STATE, Zip
PRONE
I certify under penalty of perjury that I am the properly owner or authorized agent of the property owner. I certify that to the best
in of this application Is true and correct. I certify that I will comply with
of my knowledge, the information submitted support permit
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 Cityy of Federal Way as to any claim (including costs, expenses, and attorneys' Ass 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 offloors and employees, upon the accuracy of the
information supplied to the city as apart of this application.
�� ���•��
SIGNATURE: DATE
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C.�tF�•ST�N tSTA+c� N
PRINT NAME' _
Bulletin #100 - April 14, 2010 Pagel of 3 U11andoutsTemlit Application
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