14-103270 • • - 41321b
CITY OF A PERMIT SF MF CO ME PL DE E FP
Federal Way
COMMUNITY DEVELOPMENT SERVICESRGCEIVEA ) SLICATION
253-835-2607•FAX 253-835-2609
ww mato((ederalwau.com
JUL 0 3 2014
SITE ADDRESS SUITE/UNIT#
5• `' :r' '''-:LWeal floor 505 5. -53e41 SJ Lin; I` 3•N)
ii
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3,600.00 9264800270 _ -
- - _ -
TYPE OF PERMIT El BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) 3rd floor Tenant X
PROJECT DESCRIPTION
Detailed description of work to . • • • ' • • ' ' . 1 • • 1 . ' • 1 ' 1 ' A • • I.
be included on this permit only
NAME PRIMARY
PROPERTY OWNER FSP FEDERAL WAY CORP PHONE
MAILING ADDRESS EMAIL
i 1�'31 J CITY STATE ZIP
NAME
EvergreenFire Protection, Inc. PHONE253-252-7942
MAILING ADDRESS PO Box 998 E-MAIL greenfirepro@msn.com
CONTRACTOR
CITY Puallu Y p STATE ZIP
Wa 98371 FAX
21 ki
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
-55 WA
6 i 8 ,20 i 20-05-106411-OOBL
NAS same as above PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
—
PROJECT CONTACT NAME PHONE
(The individual to receive and Mike Hutchinson 253-381-4456
respond to all correspondence MAILING ADDRESS EMAIL
concerning this application) Evergreenfireproc msn.c.m
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 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.
vtiv
7/1/2014
SIGNATURE: 4 \ / DATE
PRINT NAME: Mike Hutchinson
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Perrnit Application