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COMMUNITYDEVELOPMENT
,�AXz 383-26 SERVICES APPLICATION
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SITE ADDRESS Ty O T L U{;,R M WA
Y
SUITE/UNIT#
35205 EIallited Parkway South
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 23, 439. 00 2 9 2 1 0 4 - 90 9 6
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING IX FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) U-Haul
PROJECT DESCRIPTION Tenant improvement work. Relocate/replace (102)
Detailed description of work to sprinklers to accommodate t.i. work.
be included on this permit only
NAME
PPROPERTY OWNER U-Haul
6 0 2-P 02-23HONE
66-6502
MAD,INGADDRESS 2727 North Central Ave E-MAIL
CITY Phoenix S'� E zrP 98004
NAME
PH
SimplexGrinnell0NE 206-291-1400
MAILING ADDRESS E-MAIL
CONTRACTOR 9520 10th Ave S. Suite 100 jastebbins@simplexgrinnell .com
CITY STATE ZIP FAX
Seattle WA 98108 206-291-1500
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE A
SIMPLL*988BG 1 /11 /13 19-99-105845-00-BL
NAME
PHONE
same as contractor
APPLICANT MAILING ADDRESS
E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and Janet Stebbins 206-291-1468
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application) 9520 10th Ave S. Suite 100 jastebbins@simplexgrinnell .com
CITY STATE ZIP
Seattle WA 98108 FAX 206-291-1500
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
Required value of$5,000 or more 0 OWNER-FINANCED
(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 as a part of this application.
SIGNATURE: .._ , v _�/rr M DATE 3/5/12
OF
PRINTNAME: Janet Stebbins
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application