15-103852 RECOVER
��°� AUG 04 2015 PERMIT PPLICATION
Federal Way
CITY OF FEDERAL WAY n70
CDS
PERMIT NUMBER S _ 1 0lY "l •1... _
;;;JJJ JJ TARGET DATE
SITE ADDRESS SUITE/UNIT#
33491 13th Place S Federal Way,98003 — "jL.55
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1800 B 7 681 900070
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING a FIRE PREVENTION
NAME OF PROJECT KING COUNTY PUBLIC HEALTH BUILDING#28
EMERGENCY REPLACEMENT OF A FAULTY FIRE ALARM PANEL
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME KING COUNTY PRIMARY PHONE
PROPERTY OWNER 206 296 0641
MAILING ADDRESS E-MAIL
500 4TH AVE ROOM 810 CARRIE.GRIFFIN@KINGCOUNTY.GOV
‘15611
""SEATTLE STATE ZIP A 98104
NAME FIRE PROTECTION INC PHONE
425 290 9600
MAILING ADDRESS EL
1730 GIBSON ROAD DAVID@FPISEATTLE.COM
CONTRACTOR
CITY EVERETT STATE ZIP FAX
WA 98204 475 353 4546
Vl
[7 1=1 61 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIREPI*021ML 07/31 /2016 20-00-102494-00-BL
NAME DAVID MOW PRIMARY PHONE
425 290 9600
APPLICANT MAILING ADDRESS E-MAIL
1730 GIBSON ROAD DAVID@FPISEATTLE.COM
\ r 61 3 CITY STATE ZIP FAX
djC EVERETT WA 98204 425 353 4546
NAME DAVID MOW _ _.... PRIMARY PHONE
PROJECT CONTACT 425 290 9600
(The individual to receive and MAILINGADDRESS 1730 GIBSON ROADE-MAILID@FPISEATTLE.COM
respond to all correspondence
concerning this application) CITY EVERETT STATE ZIP
WA 98204 Fax 425 353 4546
-
NAME
PROJECT FINANCING 0 OWNER-FIFANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 1 9.27.095)
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 Iaws.
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 • the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the c
.f PP as •art o - •pplc• on.
SIGNATU: " DATE 7/29/15
PRINT NAME.
O
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application