17-103255 RECEIVED
CITY OF
. JUL 0 7 2017 PERMIT APPLICATION
Federal Way CITY OF FEDERAL WAY PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609 +permitcenter(n?cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER / _ / D 3 d, \ _ F P
J TARGET DATE
SITE ADDRESS SUITE/UNIT#
2104 S. 320th St
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 2,500.00 O 9' , j O - -21_
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING l FIRE PREVENTION
NAME OF PROJECT Mod Pizza
Install new Fire Alarm System for Mod Pizza Tenant Improvement.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
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
Fire Systems West, Inc.
APPLICANT MAILING ADDRESS E-MAIL
Same
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@
respond to all correspondence firesystemswest.com
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 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 harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of suc aim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises t of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city part of this application.
SIGNATURE: DATE 07/07/2017
PRINT NAME: att Carlman
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application