17-105114 RECEIVED
A.: OCT 2 3 2017 PERMIT APPLICATION
CITY OFF1d�i aay CITY OF FEDERAL WAY PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
COMMUNE-yDEVELOPMENT253-835-2607+FAX 253-835-2609+permitcenter(a?citvoffederalway.com
PERMIT NUM / 7� _ /O5 /L9C / TARGET DATE
SITE ADDRESS SUITE/UNIT#
34503 9th South Federal Way, 98003
PROJECT VAION ZONING ASSESSOR'S TAX/PARCEL#
$ 16,460.6TYPE PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME ROJECT St. Francis Medical Pavilion Fire Panel Replacement
Replacement of existing fire alarm control panel and remote annunciator. New components
PROJECT DRIPTION
Detailed descn of work to are fully compatible with existing field devices which will remain.
be included on permit only
NAME - - PRIMARY PHONE
Clise Properties 206-623-7500
PROPERTY OWNER MAILING ADDRESS E-MAIL
1700 7th Ave. Suite#1800
CITY STATE ZIP
Seattle WA 98101
-
NAME PHONE
Performance Systems Integration 425-368-4201
MAILING ADDRESS E-MAIL
CONTRACTOR 19310 North Creek Parkway#109 carissa@psintegrated.com
CITY STATE ZIP FAX
Bothell WA 98011 425-368-4208
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PERFOS*980M4 7 / 27 / 18 20-16-100160-00-BL
NAME _._ _-_ _.. ._ __. .. -
PRIMARY PHONE
Carissa Thomson 425-368-4201
APPLICANT MAILING ADDRESS E-MAIL
19310 North Creek Parkway#109 carissa@psintegrated.com
CITY STATE ZIP FAX
Bothell WA 98011 425-368-4208
NAME _ __. __. _ _ .._..
PRIMARY PHONE
PROJECT CONTACT Carissa Thomson 425-368-4201
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 19310 North Creek Parkway#109 carissa@psintegrated.com
concerning this application) CITY STATE ZIP FAX
Bothell WA 98011 425-368-4208
FAME
PROJECT FINANCING
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 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.
4
SIGNATURE: '=_,L,� DATE 10/20/2017
PRINT NAME: Carissa Thou i
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application