12-102646 111111
• .110L -- __LOA 2 (ii
PERMIT
Federal Way RECEIVES CO ME PL DE E
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607.FAX 253-835-2609
u.a rw.citwlivrieralway.rnm ZU 12
SITE ADDRESS CITY nF FEDERQ� WAY
SUITE/UNIT#
33501 1st Way South CDS 1st floor amulatory
PROJECT VALUATION. ZONING ASSESSOR'S TAX/PARCEL# roll dOOr
$ 3101 . 48 OP 9 2 6 5 0 4 _ 0 0 1 0
TYPE OF PERMIT ElBUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING 1X FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Virginia Mason, 1st Floor Ambulatory Roll Door
PROJECT DESCRIPTION Add (6) smoke sensors, (3) control ZAM, (3) remote relays
Detailed description of work to to 1st Floor Ambulatory Surgery Roll Door Additions .
be included on this permit only Joint venture between SimplexGrinnell & Sasco Electric.
NAME PRIMARY PHONE
PROPERTY OWNER Virginia Mason Clinic
MAILING ADDRESS E-MAIL
33501 1st Way South
CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
Sasco Electric 425-806-8400
MAILING ADDRESS E-MAIL
CONTRACTOR 16650 Woodinville-Redmond Road
CITY STATE
ZIPWoodinville WA 98072 FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
SASCOE*051R6 12 /26 /13 601677475
NAME
SimplexGrinnellNE
D 206-291-1400
APPLICANT MAILING ADDRESS E-MAIL
9520 10th Ave S, Suite 100 jastebbins@simplexgrinnell .com
CITY STATE ZIP FAX
Seattle WA 98108 206-291-1500
PROJECT CONTACT NAME PHONE
(The Individual toreceive and Janet Stebbins/SimplexGrinnell 206-291-1468
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 9520 10th Ave S, Suite 100 jastehhins(asimplexgrinnel l , com
CITY STATE ZIP FAX
Seattle WA 98108 206-291-1500
ALTERNATE CONTACT NAME: PHONE E-MAIL
Nicole Michione 206-291-1463
PROJECT FINANCING NAME
13 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS.CITY.STATE.ZIP PHONE
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:
/%�/ 1, ` yS o(,ISG fsGte/1 DATE 06/11 /2012
PRINTNAMi.". Janet Stebbins for SimplexGrinnell
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application