14-102821A
4117 Or
Federal Way
WCEIVED 0
PERMIT APPLICATION
JUN 13 2014
CITY OF FEDERAL WAY
PERMIT NUMBERJq j�
y� A T d,- ( — � � TARGET DATE
r_____J 'Plo
SITE ADDRESS
SUITE/UNIT
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL M
$ 5,862.00
1 7 2 1 0 4 _ 9 0 0 4
_ _. - � -
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING L3(RRE PREVENTION
NAME OF PROJECT
CELEBRATION SR. LIVING APARTMENTS COMMUNITY BLDG
INSTALL A NEW WET AUTOMATIC SPRINKLER SYSTEM WITHIN
PROJECT DESCRIPTION
Detailed description of work to
THE NEW 3 STORY BUILDING r3 - 1 U 13),E
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
CELEBRATION SENIOR LIVING
M"201 27 ADDRESS
AVE. S E
CITY
PUYALLUP
STATE I
WA
ZIP
98374
NAME
PHONE
CUSTOM SPRINKLER CORP
425-413-9225
MAILING ADDRESS
E-MAIL.
CONTRACTOR
P 0 BOX 1137
CUSTOMSPRINK@AOL.COM
CITY
MAPLE VALLEY
STATE
WA
ZIP 98038
FAX
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE B
NAME
PRIMARY PHONE
SAME ASCONTRACTOR
MAILING ADDRESS
EMAIL
APPLICANT
CITY
STATS I ZLP
FAX
PROJECT CONTACT
NAME PHIL FRANCE
PRIMARY PHONE
^
MALMNG ADDRESS
P 0 BOX 1137
1LMAIL
CUSTOMSPRINK@AOL.COM
(The individual to receive and
respond to all correspondence
CITY
MAPLE VALLEY
STATE
WA
ZIP
98038
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
Required value of $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 authorised 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.
[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 part of this application.
SIGNATURE: DATE
PRINT NAME:14
Bulletin #100 —January 1, 2013 Page I of 3 k:\I-Iandouts\Permit Application