12-104620 •
ciry°r.'^ • PERMIT
° — 10 ( 0
Federal Way F MF CO ME PL DE EN t P
COMMUNITY DEVELOPMENT SERVICES APP N
253-835-2607•FAX 253-835-2609
www.cituoffederalwat.corn r.
SITE ADDRESS
OCT 0 9 2012 SUITE/UNIT#
.A:2,1 1 J I s l S. CITY OF FEDERAL WAY _ ) 1 --
PROJECT VALUATION ZONING ASR'S TAX/PARCEL#
$ 0 0 0 C9 'ti C\ Z , .- 0 y - 0 1 s c)
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ENGINEERING a FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Dr Trish Kh o TI
Add and relocate heads in existing building for new TI.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Cuna Mutual Investment Corp.
MAILING ADDRESS E-MAIL
2633 Eastlake Ave E#300
CITY STATE ZIP
Seattle WA
NAME PHONE
Patriot Fire Protection, INC. 253-926-2290
MAILING ADDRESS E-MAIL
CONTRACTOR 2707 70th Ave E
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PATRIFP099CF 10 05 12 19-91-101988-00-BL
NAME PHONE
John Dacca 253-284-3467
APPLICANT MAILING ADDRESS E-MAIL
2707 70th Ave E johnd@patriotfire.com
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
PROJECT CONTACT NAME PHONE
(The individual to receive and Same as Applicant
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 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 art of this application. j
SIGNATURE: DATE tfi/9/Z
PRINT NAME: 6 ki i`l 70A.CC A
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application