16-106152PERMIT APPLICATION
f� r 1+ A la
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003 -6325
UCI. LI 253- 835 -2607 + FAX 253 - 835 -2609 + Termitcenter (ii,:citvoffederalway.com
Cay op FEDERAL Wk
PERMIT NUMBER -1 `E' _ ) O � IF
P)�,-
TARGET DATE
SITE ADDRESS
SUITE /UNIT #
34834 Wayerhaeuser Way S Federal Way, WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL #
$ 1,500.00
2 2 2 t 4- 0 3_t
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING C5t FIRE PREVENTION
NAME OF PROJECT
World Vision
Relocate Vesda Unit and Monitor Module.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
World Vision US
PROPERTY OWNER
MAILING ADDRESS
PO Box 9716
E -MAIL
CITY
Federal Wa
STATE
WA
ZIP
98063
NFire Systems West, Inc.
P253- 833 -1248
CONTRACTOR
MAILING ADDRESS
206 Frontage Rd N, Suite -C
E -MAIL
rzgrvige firesystemswes
CITY
STATE
ZIP
FAX
Pacific
WA
98047
WA STATE CONTRACTOR'S LICENSE #
FIRESWI055LW
EXPIRATION DATE
p6 i 16 i 1Z
FEDERAL WAY BUSINESS LICENSE #
19 -87- 000014 -00 -BL
NAME
PRIMARY PHONE
SAME
MAILING ADDRESS
E -MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
N
att Carlman
PRIMARY PHONE
253-951-6005
M LING ADDRESS
Same
E -MAIL
matte (Mires stemswest.
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER - FINANCED
When value is $5, 000 or more
(RC'W 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 clai arts out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to a cit a part of this application.
SIGNATURE: DATE 12/28/2016
PRINT NAME: Att 6arlman
Bulletin #100 -- January 29, 2016 Page 1 of k: \Handouts \Permit Application
;om