17-101932 CITY OF PERMIT APDL N
Federal Way �� ��C��, Q
i 7 Q ( j 3 APR 21 2017
PERMIT NUMBER
_ TARGET DATE CQMMUNi1T`F`DEV OPMENT
SITE ADDRESS SUITE/UNIT#
1211 S 320th St, Federal Way, WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
G000. 00 A_ 4 - 0 0 3 0
TYPE OF PERMIT ❑ BUILDING D PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT Planet Fitness - Federal Way Remodel
Add/ Relocate QR pendent head to new ceiling of remodeled spaces
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
MGP IX SUNSET SQUARE LLC
PROPERTY OWNER
MAILING ADDRESS E-MAIL
425 CALIFORNIA ST 11TH FLR
CITY STATE ZIP
SAN FRANCISCO CA 94104
NAME Reliance Fire Protection Inc. PHONE
MAILING ADDRESS 8168 304th Ave SE E-MAIL
CONTRACTOR
CITY Preston STATEFAX
aZIP 98050
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
RELIAFP 102L1 7 / 12 /2017
NAME Andrew Olson PRIMARY PHONE
APPLICANT MAILING ADDRESS 8168 304th Ave SE E-MAIL
CITY STATE ZIP FAX
Preston WA 98050
NAME Kevin Jensen PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS 8168 304th Ave SE E-MAIL
respond to all correspondence kevin@reliancefire.com
concerning this application) CITY STATE ZIP FAX
Preston WA 98050
NAME
PROJECT FINANCING it 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 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: 6-2")Thr‘ DATE (4 �J 1 a / / 1 7
PRINT NAME: A
Bulletin#100—January 1,2013 Page 1 of 3 k:UFlandouts\Permit Application