11-101800 ( 0 / X 60
Federal Wayc,,,,, ,....,"%t 0 PERMIT w MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES N N
253-835-2607*FAX 253-835-2609
tnmu+.cfte otfedere,,nat.com .w _ r
MAY 11 'r'j
SITE ADDRESS SI HTE/UNIT#
135 S 312th St ," CITY OF FEDERAL WAY
PROJECT VALUATION ZONING 433ESSOR'S TAX/PARCEL 0
$ 5993.00 C V 7 0 8 2 1 0 4 - 9 1 0 6
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING • FIRE PREVENTION
NAME OP'(Tenant wn°Dame) Learning Group Inc/ Childtime
Install a Fire Alarm System including 1 Control and 25 Devices
PROJECT DESCRIPTION " 00 -
Detailed description of work to
be included on this permit only
v
NAME PRIMARY PHONE
PROPERTY OWNER GREYSTONE MEADOWS APTS 253-946-1137
MAILING ADDRESS E-MAIL
31500 1ST AVE S
CITY STATE ZIP
Federal Way WA 98003 a
NAME PHONE
ADT SECURITY SERVICES 360-945-2787
MAILING ADDRESS E-MAIL
CONTRACTOR 11824 N CREEK PKWY N,STE#105 William@nwpermit.com
CITY STATE ZIP FAX
Bothell WA 98011
WA STATE CONTRACTOR'S LICENSE# • EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ADTSESI032O5 0 9 / 2 5/ 11 19-98-105567-00-BL
NAME PHONE
Northwest Permit(AGENT ONLY) 360-945-2787
APPLICANT MAILING ADDRESS E-MAIL
1345 Gulf Rd William@nwpermit.com
CITY STATE ZIP FAX
Point Roberts WA 98281 360-945-2091
PROJECT CONTACT NAME PRONE
William Millhollin 3SO.945.2787
(The individual to receive and -
MAILING ADDRESS respond to all correspondence 1345GulfRd WillE-MAILlnw rmit.eom
concerning this application) ` @ pe
CITY STATE ZIP FAX
Point Roberts WA 98281 360-945-2091
ALTERNATE CONTACT NAME: PHONE E-MAIL
Naida Khan 360-945-0234 Naida@nwpermit.com
PROJECT FINANCING NAME OWNER-FINANCED
Required value of$5,000 or more ADT SECURITY SERVICES
(RCW 19.27.095) MAILING ADDRESS.CITY,STATE,ZIP PHONE
11824 N CREEK PKWY N,STE#10055 WA,98003 360-945-2787
I certify under penalty of perjury that I am the property ownerar Ittolkorised agent of the property Amer.I cert¢fy 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 authorised by the•isuance 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
conetruction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any mot(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim),which may be made by INISperson,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
informatio ,,, . to the city as a this application.
SIGNA
DATE ��1 !�.
PRINT N ,, ��� � � , .,-.. i..1 / .
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Bulletin#100-January 1,2011 % Page 1 of 3 k:\Handouts\Permit Application