14-104014clwv or �,
Federal Way
PERMIT4kPPLICATION
RXIMM
s / �/� �) AUG 0 8 2014
PERMIT NUMBER y — f-
/
OF FEAIE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
1,835.00
1 7 2.. 1 0 4 _ 9 0 0 4
_ _ __ _ _ _ _ — —
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING C3(FIRE PREVENTION
NAME OF PROJECT
CELEBRATION SR. LIVING APARTMENTS COMMUNITY BLDG
INSTALL NEW 4" DIP FIRE SERVICE SUPPLY LINE FROM EAST BLDG
PROJECT DESCRIPTION
Detailed description of work to
SPRINKLER ROOM, INTO COMMUNITY BLDG STORAGE ROOM 107.
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
CELEBRATION SENIOR LIVING
201 27 TH AVE. S E
CITY
STATE
ZIP
PUYALLUP
WA I
98374
NAME
CUSTOM SPRINKLER CORP
PHONE
425-413-9225
MAILING ADDRESS
EMAIL
CONTRACTOR
P O BOX 1137
CUSTOMSPRINK@AOL.COM
CITY
MAPLE VALLEY
STATE
WA
ZIP 98038
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
SAME ASCONTRACTOR
MAILING ADDRESS
EMAIL
APPLICANT
CITY
STATE I
ZIP
FAX
PROJECT CONTACT
NAME
PHIL FRANCE
PRIMARY PHONE
MAILING ADDRESS
EMAIL
CUSTOMSPRINK@AOL.COM
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAR
concerning this application)
MAPLE VALLEY
98038
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 perjW y that I am the property owner or authorised agent of the property owner. I certVy 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.
I further agree to hold harmless the City of Federal Way as to any claim ltncludtng 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
injbrmation supplied to the city as apart of this application.
SIGNATURE: DATE 08/08/14
PRINT NAME: PHIL FRANCE
Bulletin #100 - January 1, 2013 Page 1 of 3 kAHandouts\Permit Application