13-100624 • o o ol
Federal PERMIT SF MF CO ME PL DE EN Ot
Federal way RECEIVED
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607•FAX 253-835-2609
www.dtuoffederalwamcom FEB 4 8 2013 I
SITE ADDRESS CITY OF FEDERLWiT r
4428 S CoFi m nc A/ay Z(14 S Col-Wok)S WAY CDS
ThO CT VALEATI N ZONING ASSESSORS TAX/PARCEL S
$ 7,400 7 6 2 2 4 0 _ 0 0 1 0
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑MECHANICAL
0 DEMOLITION ❑ ENGINEERING En FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) NEV A _Commons Demo
S "
Cut&cap fire sprinkler piping for CMU and framed walls
PROJECT DESCRIPTION
Detailed description of work to Add (1) 1 1/2"hose valve and connect to new 8"UG supply.
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Steadfast Commons LLC
MAILING ADDRESS E-MAIL
1928 S Commons Way
CITY STATE I ZIP
Federal Way [WA 98003
NAME PHONE
Fire Sprinklers Incorporated 253-826-0099
MAILING ADDRESS E-MAIL
CONTRACTOR 1524 45th Street E-Suite 102 travis@tlrfsprinklerSinC.COrft
CITY STATE ZIP FAX
Sumner _WA 98390 253-826-1033
WA STATE CONTRACTOR'S LICENSE S EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE S
FIRESI*988RJ 12 11 14 20-05-100633-00-BL
NAME PHONE
Same As Contractor
APPLICANT MAILING ADDRESS E-MAIL
CITY ' STATE Il r ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAM: PHONE E-MAIL
PROJECT FINANCING
NAME
0 OWNER-FINANCED
Required value of$5,000 or more
IRCW 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 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.
SIGNATURD. �'�^ DATE
2/8/13
PRINT NAME:
Travis Kinne
Bulletin#100—January I,2011 Page 1 of 3 k:\Handouts\Permit Application