16-102211my.
Federal Way
COMMUMTY DEVELOPMENT' SERVICES
253-835-2607• FAX 253-835-2609
www.dtUoffedera(u .coni
0 PERMIT
APPLI CATI O N
C O_ 1
Cry
2-y
I C
4 MF CO
ME
PL DE
ENO
RECEIVE®
MAY 0 9 2016
SITE ADDRESS 35602 4th place sw CITY of DSRAL WA
SHITE
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL 0
$ 3,800.00
_ 3021049181
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
(tenant Name/Homeowner Last Name)
project S-19
PROJECT DESCRIPTION
Detailed description of Mork to
Install a npw NFPA 33D fire sprinkler system
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAD ING ADDRESS
EMAIL
CITY
STATE I
ZIP
NAME Evergreen Fire Protection, Inc.
PHONE 253-252-7942
CONTRACTOR
MAIIINGADDRE88
PO Box 998
ML
Eveergreenfirepro@msn.com
Puyallup
Aja
22P 98371
FAX
WA STATE CONTRACTOR'S LICENSE M
Ever f 967iz
E$PIRATION DATE
6 / 8 /201
FEDERAL WAY BUSINESS LICENSE 11
20-05-106411-OOBL
NAME same as above
PHONE
APPLICANT
MAUING ADDRESS
E-MAIL
CITY
STATE I
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAM
Mike Hutchinson
mom 253-381-4456
MAILING ADDRESS
E -MAD.
Everqreenfirepro@rnsn.cc
CITY
STATE
ZD+
FAX
ALTERNATE CONTACT NAME:
PHONE
E -MAD.
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
➢LADING ADDRESS, CITY, STATE, ZD'
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 igformation 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 ce of the city, including its officers and employees, upon the accuracy of the
information supplied to the cityas lication.
5/9/2016
SIGNATURE:\NW DATE
PRINT NAME: Mike Hutchinson
Bulletin #100 —January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
M