13-105661CITY OF 'A
Federal Way
� PERM I'1*APPLICATION
RECEIVED
PERMIT NUMBER (� _ _ rp
DEC 2 U 2013
TARGET DATE
F FEDERAL, WAY
SITE ADDRESS
8401y 33rd St
SU NIT if
200 C �3/)
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 5201.00
926500 _ 0150
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING 13*ft PREVENTION
NAME OF PROJECT
Federal Way Asset Management
TI addition of 1 NAC, 16 strobes and horn/strobes, and 1 smoke
PROJECT DESCRIPTION
Detailed description of work to
detector above NAC panel.
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
WEYERHAEUSER NR COMPANY
MAILING ADDRESS E-MAIL
CITY
STATE
ZIP
NAME PHONE
Convergint Technologies LLC 425-272-2250
MAILING ADDRESS E-MAIL
CONTRACTOR
450 Shattuck Ave S
CITY
Renton
STATE
WA
ZIP FAX
98057
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE #
CONVETL984BQ
01/ 18 2014 42662
NAME PRIMARY PHONE
Derek M. 011om 425-766-5461
APPLICANT
MAILING ADDRESS E-MAIL
450 Shattuck Ave S erek.ollom@convergint.
CITY
Renton
STATE
A
ZIP FAX
98057
PROJECT CONTACT
NAME PRIMARY PHONE
Derek M. 011om 425-766-5461
MAILING ADDRESS E-MAIL
450 Shattuck Ave S erek . ollom@convergint .
(The individual to receive and
respond to all correspondence
CITY
Renton
STATE
A
ZIP FAX
98057
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 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 suppl ioqo the city as a part of this application.
SIGNATURE: G���/K. DATE 12 - 2013
/
PRINTNAME• Derek M. 011om
Bulletin #100 — January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application
con
::or