17-101053 PERMIT APPLICATION
CITY OF
��� PERMIT CENTER+ 33325 8th Avenue South + Fede r,ice. v'= 8003-6325
Way 253-835-2607 + FAX 253-835-2609 + permitcen e aci o e eralway.com
PERMIT NUMBER l 0
TARGET DATE '7111 I`" rr ;: _*
SITE ADDRESS 37515 S 8TH AVENUE SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$5,000 COMMERCIAL 3_2_2_ 1_0_4 -9_O_9 1
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT REVIVAL SLAVIC BAPTIST CHURCH
NEW FIRE ALARM SYSTEM FOR BUILDING REMODEL
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
SLAVIC REVIVAL BAPTIST CHURCH PRIMARY PHONE
PROPERTY OWNER 37515 S 8TH AVENUE E-MAIL
FEDERAL WAY WA 98003
SECURITY SOLUTIONS NW (360)734-4940
1619N N. STATE STREET CODYS@SSNW.CO
CONTRACTOR
BELLINGHAM WA 98225 (360)647-9540
SECURSN954JG EXPIRATION DATE 20-04-105053-00-BL
04/07/2017
SAME AS CONTRACTOR PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
JASO OMER (360)746-4014
n
PROJECT CONTACT �1?1CLV .'l i ii.e N'
(The individual to receive and 1619 N. STATE STREET JASONO@SSNW.CO
respond to all correspondence
concerning this application) BELLINGHAM WA 98225 (360)647-9540
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$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.
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.OF
I
SIGNATURE: .� • ' #1 I DATE I'2 r+
PRINT NAME: 7ja,Yc t( Y
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application