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PERMIT APPLICATION
CITY OF
Federal Way RECEIVED
PERMIT NUMBER 37_ C' 2 _ F- MAY 302013
TARGET DATE CITY OF FtutRAL WAY
SITE ADDRESS SUITE/UNIT#CDS
:914 (3, 1 47.40ec ifrpvy
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3626 0 8 2 1 0 4 — 9 1 8 6
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT COMFORT DENTAL FEDERAL WAY
THE SCOPE OF THIS PROJECT IS TO INSTALL A FIRE SIGNAL EXPANDER AND
PROJECT DESCRIPTION
Detailed description of work to NOTIFICATION DEVICES FOR THE PURPOSE OF TENANT IMPROVEMENT.
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER PAVILION CENTER ASSOCIATES
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
SMITH FIRE SYSTEMS MANAGEMENT 253-248-2004
MAILING ADDRESS E-MAIL
CONTRACTOR 1106 54TH AVE E SJERKE@SMITHFIRE.COM
CITY STATE ZIP FAX
TACOMA WA 98424 253-926-0726
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
SMITHFS946LO 6 / 20 / 14 200610470900BL
NAME PRIMARY PHONE
SMITH FIRE SYSTEMS MANAGEMENT 253-248-2004
APPLICANT MAILING ADDRESS E-MAIL
1106 54TH AVE E SJERKE@SMITHFIRE.COM
CITY STATE ZIP FAX
TACOMA WA 98424 253-926-0726
NAME PRIMARY PHONE
PROJECT CONTACT SCOTT JERKE 253-248-2004
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 1106 54TH AVE E SJERKE
concerning this application) CITY STATE ZIP FAX
TACOMA WA 98424 253-926-0726
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$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 ity of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such im),which may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises ut of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city a Oart of this ap lication.
SIGNATURE: DATE 5/24/13
PRINT NAME: SCOTT JERKE
Bulletin#100—January 1,2013 Page 1 of 3 k:\I-Iandouts\Permit Application