14-104428 CITY Or - - PERMIT flPPLICATION
Federal Way y�
R '91
1 0 4 4- z& FP AUG 2 8 2014
PERMIT NUMBER 1
TARGET DATE
('tEYS F FEDERAL WAY
SITE ADDRESS SUITE/Litt S
204 S 348TH ST., FEDERAL WAY, 98003 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL ii
$ 3784.32 2 0 2 1 0 4 - 9 1 3 4
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING al FIRE PREVENTION
NAME OF PROJECT MAI TRI YOGA
REPLACE EXISTING FIRE ALARM PANEL WITH POTTER PFC 5004E.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAI TRI YOGA (253)906-7573
MAILING ADDRESS E-MAIL
204 S 248TH ST.
CITY STATE ZIP
FEDERAL WAY WA 98003
NAME PHONE
ALARM CENTER INC. (800)354-1555
MAILING ADDRESS E-MAIL
CONTRACTOR PO BOX 3407 sanderson@alarmcenterinc.com
CITY STATE ZIP FAX
LACEY WA 98509
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ALARMCI055CW 02/ 15 / 16 20-00-101-452-00-BL
NAME PRIMARY PHONE
SAME AS ABOVE
APPLICANT MAILING ADDRESS E-MAIL
SAME AS ABOVE
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT SCOTT ANDERSON (800)354-1555
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence PO BOX 3407 sanderson@alarmcenterinc.com
concerning this application) CITY STATE ZIP FAX
LACEY WA 98509
PROJECT FINANCING NAME 0 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 supplied to the city as a part of this application.
SIGNATURE: v DATE 0/ZSfpy
PRINT NAME: SCOTT ANDERSON
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application