14-103598 CITY OF
PERMITIPPLICATION
Federal Way ; .
RWVED 1
PERMIT NUMBER�_i — l a 3 S / i_ - F JltlaPN, )
TARGET DATE
SITE ADDRESS Cj'n( Q sCD # WAY
32032 Weyerhauser Way S, Fed Way, Wa
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 12218 . 00 / SZ / 0 Zif �'j o65- -
TYPE OF PERMIT D BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING Ea FIRE PREVENTION
NAME OF PROJECT Washington Education Association
Replacement of fire alarm control panel . Per Chris
PROJECT DESCRIPTION Ingham with South King Fire - Submitting cut sheet
Detailed description of work to
be included on this permit only for n e W panel only
NAME y PRIMARY PHONE
PROPERTY OWNER Washington Education Association 253-941-6700
MAILING ADDRESS E-MAIL
Same As Above
CITY STATE ZIP
NMConvergint Technologies PHONE425-272-2250
MAILING ADDRESS E-MAIL
CONTRACTOR 450 Shattuck Ave
CITY STATE ZIP FAX
Renton WA 98057
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CONVETL984BQ 01 / 18 / 16 20-05-102938-00-BL
NAME PRIMARY PHONE
Derek M 011om 425-766-5461
APPLICANT MAILING ADDRESS E-MAIL
13108 SE 245th St derek.ollom@convergint.com
CITY STATE ZIP FAX
Kent WA 98030
NAME PRIMARY PHONE
PROJECT CONTACT Derek M 011om
(The individual to receive and MAILIGAADRESs E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME fl OWNER-FINANCED
Washington Education Association xx
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095) SAA
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 supplied0 he city as a part of this a•,lication.
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4
SIGNATURE: `moi ,� / DATE 07—
i/('ed/
PRINT NAME: Derek M. 011om
Bulletin#100—January 1,2013 Page 1 of 3 k:\I-Iandouts\Permit Application