12-105638 RECEIVED _ L 0 5 Co 3 3-
CITY OFPERMIT SF MF CO ME PL DE EN fp
Federal Wax 19 2012
COMMUM7Y DEVELOPMENT SERVICES AP P LI CATION
253:„.„.,607•.....F2 '-isYsdF FEDERAL WAY
.............�_...__._:..._.._, CDS
SITE ADDRESS
SUITE/UNIT#
3221 S 3ZN" AVE . S,
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$
S Cr) 0o1C) 2 l S Co S - C O g
TYPE OF PERMIT CIBUILDING ElPLUMBING IIMECHANICAL
❑ DEMOLITION ❑ ENGINEERING p FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Davita T.I.
Add and Relocate sprinklers per new T.I.walls and ceilings
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME _ _ PRIMARY PHONE .. ,...
PROPERTY OWNER W t Y E T- NAE USE >Z_
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME _ _ .PHONE
Patriot Fire Protection,INC. 253-926-2290
MAILING ADDRESS E-MAIL
CONTRACTOR 2707 70th Ave E johnd@patriotfire.com
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PATRIFP099CF 10 05 /13 19-91-101988-00-BL
NAME PHONE
John Dacca 253-405-4469
APPLICANT MAILING ADDRESS E-MAIL
2707 70th Ave E johnd@patriotfire.com
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
PROJECT CONTACT NAME
PHONE
John Dacca 253-405-4469
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 2707 70th Ave E johnd@patriotfire.com
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
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 suppliedtothe c o application.
SIGNATURE: + DATE
12-18-12
"
PRINT NAME: OI111 Dacca
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application