14-105547 CITY OF
PERMIAPPLICATION
Federal Way RECEIVED
OCT 2 3 2014
PERMIT NUMBER
TARGET DATE CITY OF FEDERAL WAY
SITE ADDRESS SUITE/UNIT it D S
1900A S Commons, Federal Way WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL# /(
$ 5500.00 CQ 2 2 ` (- D _ CO 10
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT Costa Vida
Fire Sprinkler T.I.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE _
Emerald Fire 253-857-2056
MAILING ADDRESS E-MAIL
CONTRACTOR 11021 Cramer Road KPN angiev @emeraldfirellc.com
CITY STATE ZIP FAX
Gig Harbor WA 98329 253-857-2312
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
u : I • :s : 7 19 1 . 2014-104959-00-BL
NAME PRIMARY PHONE
Emerald Fire 253-857-2056
APPLICANT MAILING ADDRESS E-MAIL
11021 Cramer Road KPN angiev @emeraldfirelic.com
CITY STATE ZIP FAX
Gi• Harbor WA 98329 253-857-2312
NAME PRIMARY PHONE
PROJECT CONTACT Keith Hillstrom /Angie Voelpel 253-857-2056
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 11021 Cramer Road KPN angiev @emeraldfrellc.com
concerning this application) CITY Gi• Harbor ZI 98329 253-857-2312
PROJECT FINANCING NAME C] OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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.
'fees in
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys fe incurred
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: OUE7O DATE 10-13-14
PRINT NAME: Angie Voelpel
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application