16-101729 irceDIED
•{
car or APR U7 2016 PERMIT APPLICATION
Federal Way
cm OF FEDERAL WAY
• CDS
PERMIT NUMBER 1 ( — I 1
l —
- TARGET DATE
SITE ADDRESS SUITE/UNIT N
' PACIFIC HWY S, FEDERAL WAY, WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL P
$ 3700.00 1 5 0 0 5 0 _ 0 1 1 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT Legendary Doughnuts
FIRE SPRINKLER T.I. (23 SPRINKLERS)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER HARSCH INVESTMENT PROPS LLC
MAILING ADDRESS E-MAIL
CITY STATE ZIP
PHONE
NAME EMERALD FIRE LLC 253-857-2056
MAILING ADDRESS E-MAIL
CONTRACTOR
11021 CRAMER RD KPN ANGIEV@EMERALDFIRELLC.COM
CITY STATE ZIP FAX
GIG HARBOR WA 98329 253-857-2312
WA STATE CONTRACTOR'S LICENSE i EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
EMERAFL980MR 7 / 19 / 16 20-14-104959-00-BL
NAME PRIMARY PHONE
EMERALD FIRE LLC 253-R57-2056
MAILING ADDRESS
APPLICANT 11021 CRAMER RD KPN ANGIEV@EMERALDFIRELLC.COM
TYCI GIGHARBOR STATE ZIP FAX
WA 98329 253-857-2312
NAME PRIMARY PHONE
PROJECT CONTACT KEITH HILLSTROM 253-857-2056
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
11021 CRAMER RD KPN KEITHHQEMERALDFIRELLC
concerning this application) CITY STATE 28329
GIG HARBOR WA FAX
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 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: UriereierYic)
0 DATEAPRIL 5, 2016
PRINT NAME: ANGIE VOELPEL
Bulletin#100-January 1,2013 Page 1 of 3 k:\Iandouts\Permit Application