17-103109 PERMIT APPLICATION
CITY OF ,. '‘4
. VE
Federal Way PERMIT CENTER+33325 8th Avenue SouthREG 8S
03-6325
253-835-2607+ FAX 253-835-2609+permitcenter2aci:offederalway.com
�
j JUN 287017
PERMIT NUMBER - ' v _ �� CITY OF FEDERAL WAY
TARGET DATE COMMUNITY Dt:VE pp
mEtirr
SITE ADDRESS SUITE/UNIT#
1430 S. 330th St
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 6,500.00 1 7 2 1 0 4 9 0 4 5
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING Z FIRE PREVENTION
NAME OF PROJECT Church of Blessings
Install new Fire Alarm Power Supply, Voice Amp and notification
PROJECT DESCRIPTION devices for building expansion.
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
Church of Blessings
PROPERTY OWNER MAILING ADDRESS E-MAIL
1430 S. 330th St
CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
Fire Systems West, Inc. 253-833-1248
MAILING ADDRESS E-MAIL.
206 Frontage Rd N, Suite-C service@firesystemswest.com
CONTRACTOR
CITY STATE ZIP FAX
Pacific WA 98047
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIRESWI055LW 06 / 16 /18 19-87-000014-00-BL
NAME PRIMARY PHONE
Same
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Matt Carlman 253-951-6005
(The individual to receive and MAILING ADDRESS E-MAIL
Same mattc@firesystemswest.com to all correspondence firesystemswest.com
concerning this application) CITY STATE ZIP FAX
NAME..
PROJECT FINANCING L 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 harmlesst e City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred in
the investigation and defense of su, claim),which may be made by any person,including the undersigned, and filed against the city,
but only where such claim aris ut of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the cityb'a part of this application.
SIGNATURE: DATE 06/28/2017
PRINT NAME: Matt Carljnan
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Pennit Application