13-104684 CITY of'A.
PERMITPPLICN
Federal Way
OCT 22 2013
(/ CITY OF FEDERAL WAY
PERMIT NUMBER - �^ _ TARGET DATE CDS
— — —
SITE ADDRESS � 4 34- S�� A�� SUITE/UNIT#
s' 103 `d .20d
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# 6094300000
7,000 — — — —
TYPE OF PERMIT D BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING it FIRE PREVENTION
NAME OF PROJECT Keller Williams Realty
Fire Systems West will be adding and/or relocating devices to accommodate for tenant T.I.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 9TH AVENUE PAVILION N/A
MAILING ADDRESS E-MAIL
33434 8th Avenue South PhiL@firesystemswest.com
CITY STATE ZIP
Federal Way WA 98003
NAME PHONE
Fire Systems West,Inc. 253-833-1248
_.uv.
MAILING ADDRESS E-MAIL ...
CONTRACTOR 206 Frontage Road North PhiL@firesystemswest.com
CITY STATE ZIP FAX
Pacific WA 98047 253-735-0113
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIRESWI 055LW 12 / 31 / 13 19-87-000014-00-BL
NAME PRIMARY PHONE
Phi Le 253-202-7045
APPLICANT MAILING ADDRESS E-MAIL
same as contractor PhiL@firesystemswest.com
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Phi Le 253-202-7045
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence Same as contractor
concerning this application) CITY STATE ZIP 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;tit a pa of this application.
,..
SIGNATURE: DATE
10/22/13
PRINT NAME: Phi Le
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application