11-105024 • • T t -o Z4
CITY or
•i \./ PERMIT SF MF CO ME PL DE ENEcEO
Federal Wa3,R.
COMMUNITY DEVELOPMENT
0: M53 SERVICES
APPLICATION - is 1- roof i
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www.cituoitederalwau.com i- ;UP>
CITY OF FEDERAL WAY )97----
SITE ADDRESS CCAS SUITE/UNIT#
31433 Pacific Hwy. S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4,500 ,.Z 10 4 - q o / a
D BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Xfinity
Install fire alarm system for new tenant in existing building.
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
IC Kirby Electric Inc. 253 859-2000
MAILING ADDRESS E-MAIL
CONTRACTOR 4826 B St. NW Suite 101 derek@kirbyelectric.com
t,rfCITY STATE ZIP FAX
Auburn WA 98001 253-859-2363
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
KIRBYEI077BN 01 13 13 19-90-101897-00-BL
NAME PHONE
Derek McCoy 253-859-2000
APPLICANT MAILING ADDRESS E-MAIL
4826 B St. NW Suite 101 derek@kirbyelectric.com
CITY STATE ZIP FAX
Auburn WA 98001 253-859-2363
PROJECT CONTACT NAME PHONE
Derek McCoy 253-859-2000
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 4826 B St. NW Suite 101 derek@kirbyelectric.com
CITY STATE ZIP FAX
Auburn WA 98001 253-859-2363
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME 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 part of this application.
SIGNATURE: DATE 12/20/2011
PRINT NAME: Vitaly Kalchik
Bulletin#100—January 1,2011 Page 1 of 3 k:AHandouts\Permit Application