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CITY OF PERMIT
Federal Wa MF CO ME PL DE EN cED
DECEIVE
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607•FAX 253-835-2609
www.cityoeederalway.com MAY 2 5 2012
SITE ADDRESS CITY OF FEDERAL WAY SUITE/UNIT#
35205 Enchanted Pkwy. S.
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 8,500.00 2 9 2 1 0 4 - 9 0 9 4
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) U-haul
Install fire alarm system for new tenant.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Amerco Real Estate
MAILING ADDRESS E-MAIL
2727 N. Central Ave.
CITY STATE ZIP
Pheonix AZ 85004
NAME PHONE
Kirby Electric Inc. 253-859-2000
MAILING ADDRESS
CONTRACTOR $6 B St NW Suite 101 dE-erek@kirbyelectric.com
r CITY Auburn STATE ZIP
Q FAX c
253-8
3
9-
} WA STE CONTRACTOR'S LICENSE# WA �EXPIIRATION DATE FEDERALSWA�BUSINESS LICENSE#
( KIRBYE1077BN 01 / 13 2013 19-90-101897-00-BL
(V) NAME PHONE
Derek McCoy 253-859-2000
APPLICANT MAILING ADDRESS E-MAIL
4826 B St. NW Suite 101 derekc kirbyelectric.com
CITY STATE ZIP FAX
Auburn WA 98001 253-859-2363
PROJECT CONTACT '
Same as applicant PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME o 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 as a pa o his application.
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SIGNATURE: / ( DATE c”) (9'51(
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PRINT NAME: ('C of(c'
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application