17-102256 ..._,N_ RECEIVED PERMIT APPLICATION
CITY OF `:..
Fet:leral Way PERMIT CENTER+33325 8'h Avenue South+ Federal Way,WA 98003-6325
MAY 5 2017 253-835-2607+ FAX 253-835-2609+permitcente i_citvooffederalwav com.
CITY OF FEDERAL WAY = —.
PERMIT NUMBER M!1 D LO
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SITE ADDRESS SUITE/UNIT#
505 S 336th St 140
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 2, 500 . 00 9 2 6 4 8 0 - 0 2 7 0
TYPE OF PERMIT ❑ BUILDING El PLUMBING El MECHANICAL ❑ DEMOLITION ❑ ENGINEERING a FIRE PREVENTION
NAME OF PROJECT West Campus Sports & Orthopedic
Install new Fire Alarm power supply and notification devices.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
RH Fountain Plaza Assoc. LLC.
PROPERTY OWNER MAILING ADDRESS E-MAIL
PO Box 5003
CITY STATE ZIP
Bellevue WA 98009
NAME PHONE
Fire Systems West, Inc. 253-833-1248
MAILING ADDRESS E-MAIL
CONTRACTOR 206 Frontage Rd N, Suite-C service@firesystemswest.com
CITY STATE ZIP FAX
Pacific WA 98047
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIRESWI055LW 06 16 17 19-87-000014-00-BL
NAME PRIMARY PHONE
Fire Systems West, Inc. 253-833-1248
APPLICANT MAILING ADDRESSE-MAIL
206 Frontage Rd N, Suite-C service@firesystemswest.com
CITY STATE ZIP FAX
Pacific WA 98047
NAME PRIMARY PHONE
PROJECT CONTACT Matt Carlman 253-951-6005
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 206 Frontage Rd N, Suite-C mattc@firesystemswest.com
concerning this application) CITY STATE ZIP FAX
Pacific WA 98047
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 79.27.095)
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 a s out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tot c. as a part of this application.
SIGNATURE: DATE 05/15/2017
PRINT NAME: Matt Carlman
Bulletin#100-January 29,2016 Page 1 of 2 k:AHandouts\Permit Application