14-102820S1t101'
Federal Way
4JECEIV ED
JUN 13 2014
0
PERMIT APPLICATION
Cffy D,F FEDERAL WAY
r! CDS
PERMIT NUMBER f _ 6 _ E�
,,,,,((( TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL i)
217,468.00
1 7 2 1 0 4 _ 9 0 0 4
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING (:(FIRE PREVENTION
NAME OF PROJECT
CELEBRATION SR. LIVING APARTMENTS EAST TOWER
INSTALL A NEW WET & DRY AUTOMATIC SPRINKLER SYSTEM
PROJECT DESCRIPTION
Detailed description of Mork to
WITHIN THE NEW 6 STORY BUILDING
be included on this permit only
-/0 310
PROPERTY OWNER
NAME
CELEBRATION SENIOR LIVING
PRIMARY PRONE
201 2i TH AVE. S E
CITY
PUYALLUP
STATEWA98374
I
ZIP
NAME
PHONE
CUSTOM I P
425-413-9225
MAHJNO ADDRESS
Z-MAM
CONTRACTOR
P 0 BOX 1137
CUSTOMSPRINK AOL.COM
CITY
MAPLE VALLEY
STATE
WA
20 98038
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
i i 14
NAME
PRIMARY PHONE
SAME AS CONTRACTOR
MAILING ADDRESS
WMAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME PHIL FRANCE
PRIMARY PHONE
NAMING ADDRESS
P 0 BOX 1117
CU OMSPRINK OL.CQM
(The individual to receive and
respond to all correspondence
CITY
MAPLE VALLEY
STATE
ZIP
98038
FAX
concerning this application)
PROJECT FINANCING
NAME
0 OWNER -FINANCED
Required value of $5,000 or more
)RCW 19.27.095)
MAII.INO 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 Ajay 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 supplied to a ci as apart of this application.
SIGNATURE: DATE 6,
PRINT NAME: / 4
Bulletin #100 —January 1, 2013 Page 1 of 3 k:Wandouts\Permit Application