12-100749Feder EIVEQ PERMIT
COMMUNITY DEVEIAPMENT SE � 1 b � _ `� APPLICATION
253 - 835 -2607• FRX 253-835 -
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CITY OF FEDERAL WAY
SF MF CO ME PL DE EN FP
SITE ADDRESS
1 `i 0 S SO V'+- ' shee'+
SUITE /UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL#
$ 6898.00
- 2_ - 0
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING N FIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
Wholesale Sports
PROJECT DESCRIPTION
Add (19) Relocate 3) s riklers for new wall
Detailed description of work to
locations in tenant improvement.
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
FANA FED WAY CROSSINGS
MAILING ADDRESS
E -MAIL
1405 S 348TH ST
CITY FEDERAL WAY
STATE
ZIP 98003
NAME SimplexGrinnell
PHONE 206 - 291 -1400
CONTRACTOR
MAILING ADDRESS -
9520 10th Ave S, Suite 100
E -MAD.
CITY Seattle I
IRK 19
z8 98108
FAX 206 - 291 -1500
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
SIMPLL *988BG
01/ 11 X13
19 -99- 105845 -00 -BL
NAME
same as above
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
SimplexGrinnell /Janet Stebbins
PH �06- 291 -1468
0
(The individual to receive an
MAILING ADDRESS
same as above j astebbins
E-MAIL
simplexgrinnell . c
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
OWNER - FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I cert(fy 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 irlformation 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: DATE 2/16/12
PRINTN Tanet StPhhins/SimnlPxCrinnPll
Bulletin #100 -January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application