12-101298Ll
CITY OF
Fed r -zn
MAR ?, � 2012PERMIT APPLICATION
CITY OF s?electW AY ermits ma be obtained on -line at www.ci
D
SITE ADDRESS: I. S 320th St.
SUITE /UMT /SPACE #
ASSESSOR'S TAX /PARCEL #
CIIRRENT/PROPOSED USE
0 9 2 1 0 4_
9 2
0 8 Retail
PROJECT NAME
(Tenant or Homeottmer Last Name)
Homegoods
Add fire alarm system for tenant improvement.
Zz
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
110 i b�
kJ
NAME
PRnuARYPHONE
PROPERTY OWNER
Seatac Village Shopping Center
( 503) 242 - 2900
BIADdNG ADDRESS
E-MAIL
1121 SW Salmon St.
CITY
STATE
ZIP
PAIL
Portland
OR
97205
( ) -
NAIM
PRIMARY PRONE
Kirby Electric Inc.
( 253) 859 - 2000
MAILING ADDRESS
Z-NLAIL
ELECTRICAL
4826 B St. NW Suite 101
derek @kirbyelectric.com
CITY
STATE
ZIP
FAX
CONTRACTOR
Auburn
WA
98001
( 253 ) 859 - 2363
WA STATE CONTRACTOR'S LICENSE tl
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
KIRBYE1077BN
01/ 13
/ 13
19 -90- 101897 -00 -BL
NAME
PRIMARY PHONE
APPLICANT
Derek McCoy
( 253 ) 859 - 2000
MAIL[NO ADDRESS
E'MAn
4826 B St. NW Suite 101
derek @kirbyelectric.com
CITY
STATE
ZIP
PAR
Auburn
WA
98001
( 253) 859 - 2363
PROJECT CONTACT
NAME
Derek McCoy
PRIMARY PHONE
( 253) 859 - 2000
I certVy under penalty gfperjury that I am the property owner or authorized agent of the property owner. I certVy that to the best
Qf my knowledge, the information submitted in support of this permit application is true and correct. I certVy 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 gfFederal 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
in formation supplied to the city as a part of this application.
SIGNATURE: f �IG DATE 3/22/2012
PRINT NANZ: Vitaly Kalchik
33325 8' Avenue South ♦ Federal Way ♦ WA ♦ 98003 -6325 ♦ 253- 835 -2607 ♦ fax: 253- 835 -2609 ♦ www.cityoffederalway.com
Bulletin #f160 — January 1, 2011 Page 1 of 2 k:Ulandouts\Electrical Permit Application