11-103433 A. • •/ - c3 ±33
CITY OF PERMIT
Federal Way SF j15F CO ME PL DE EN
COMMUNITY DEVELOPMENT
0 MENTERVICES
APP LI CAT I O PREcew E
•FAX
www.cioJottederNwm(.corn AUG 1 n n011
SITE 33012 ADDRESS
Pacific Way S Cf"Q" ��� P� IX SUITE/UNIT#
S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 2000 -
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING IN FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Cash America
Replace the existing FA panel,add one smoke detector and tie in all exsiting devices.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only (Note)Per Fire Deputy Vince Faranda,drawings not necessary for submittal.
NAME PRIMARY PHONE
PROPERTY OWNER Cash America (Tenant) 253-620-5958
Clear Blue Sky LLC MAILING ADDRESS E-MAIL
33012 Pacific Way S
CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
ADT SECURITY SERVICES 360-945-2787
MAILING ADDRESS E-MAIL
CONTRACTOR 11824 NORTH CREEK PKWY N, ST#105 William@nwpermit.com
CITY STATE ZIP FAX
BOTHELL WA 98036
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ADTSESI03205 09 / 25 12011
NAME PHONE
ADT SECURITY SERVICES 360-945-2787
APPLICANT MAILING ADDRESS E-MAIL
11824 NORTH CREEK PKWY N, ST#105 William@nwpermit.com
CITY STATE ZIP FAX
BOTHELL WA 98036
PROJECT CONTACT NAME PHONE
(The individual to receive and William Millhollin 360-945-2787
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 1345 Gulf Road William@nwpermit.com
CITY STATE ZIP FAX
Point Roberts WA 98281
ALTERNATE CONTACT NAME; PHONE E-MAIL
Naida Kahn Naida@nwpermit.com
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5.000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
I certify underpenalty 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, orf ederal 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?L....?
to the city as a part of this application. nn
SIGNATURE: DATE g-o 3 - I'
PRINT NAME: T fl 1 4 Yjrp �r' Al hQi ive,I�-
Bulletin#100—January I,2011 �f Page 1 of 3 V k:AHandouts\Permit Application
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