12-105365CITY M �1�/
Federal Way
RECEIVEDPERMIT
2 7 APPLICATION
CITY OF FEDERAL WAY
mr.
SF MF CO ME PL DE EN FP
SITE ADDRESS
1300 S. 320th St.
BUITE /[iNIT 8
PROJECT VALUATION
$ 8,000.00
ZONING
ASSESSOR'S TA8/PARCELY
0 8 2 1 0 4- 9 2 4 1
TYPE OF PERMIT
0 BUILDING ❑ PLUMBING ❑ MECHANICAL
El DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT
rl'e,umt Name/Homcovmer Last Nome)
US Healthworks
PROJECT DESCRIPTION
Install fire alarm system for new tenant
Detailed description of work to
be included on this permit only
PROPERTY OWNER
Pak Chun H +LI Chon
1300 S 320th St.
Federal Way
WA
98003
Kirby Electric Inc.
253 - 859 -2000
4826 B St. NW Suite 101
Pau lh (cDkirb electric.com
CONTRACTOR
Auburn
WA
98001
253 -859 -2363
KIRBYE1077BN
01 / 13 / 13
19 -90- 101897 -00 -131-
Paul Hoskins
253- 859 -2000
APPLICANT
4826 B St. Suite 101
aulh kirb electric.com
Auburn
WA
98001
253 - 859 -2363
PROJECT CONTACT
(The individual to receive and
Same as applicant
respond to all correspondence
concerning this application)
PROJECT FINANCING
Required value of $5,000 or more
OWNER - FINANCED
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fg that to the best
of my knowledge, the itformation 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 casts, 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 a atton.
SIGNATURE: DATE —11/27/2012
PRINT NAME: Vitaly Kalchik
Bulletin #100 — January 1, 2011 Page 1 of 3 k:U3andoutslPelmit Application
VALUE of IIfECH NCAL WORE $
(a copy of bid or estimate must be provided)
Indicate hour many of each type offixture to be installed or relocated as part of this project. Do not include existin fxtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS
BOILERS
FURNACES HOT WATER TANKS
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
Indicate hour many of each type offixture to be installed or relocated as part of this project. Do not Include existing fixtures to remain.
BATHTUBS
LAVS TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS WATER HEATERS I
HOSE BIBBS
SUMPS WASHING MACHINES TOTAL FIBTURES
it' 33� 3
❑ Yes X No ❑ Yes ® No
Bulletin #100 -January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application