16-1033511b •
A* PERMIT APPLICATION
CITY OF *�
PERMIT CENTER + 33325 8w Avenue South + Federal Wav WA 98003-6325
Federal ay 253-835-2607 + FAX 253-835-2609 + ge E RjR a ay.com
I FP�j� S
PERMIT NUMBER Ko _ !
- TARGET DATE JUL 13 2016
L -17Y OF FEDERAL WAY
SITE ADDRESS
SurtzmihT N
33520 21 ST AVE SW FEDERAL WAY, WA
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$ 44,000.00
1 3 2 1 0 3- 9 0 9 8
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING IN FIRE PREVENTION
NAME OF PROJECT
V S
INSALLING NEW WET SYSTEM AS SHOWN ON PLAN.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAM
CITY
STATE
ZIP
NAME COSCO FIRE PROTECTION
PHONE 206-438-3360
MAILING ADDRESS
4308 S 131ST PL
E-MAIL
CONTRACTOR
CITY TUKWILA
STATE
WA
ZIP98168
FAX 206-438-3356
WA STATE CONTRACTOR'S LICENSE M
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
COSCOFP110NM
01 / 13 / 2017
10.01 - 101 Obt-1 - 00'�I'
NAME
DEARIO BIARE
PRIMARY PHONE
206-348-3384
APPLICANT
MAILING ADDRESS
4308 S 131 ST PL
E-MAIL
dbiare@coscofire.com
CITY
STATE
ZIP
FAX
TUKWILA
I WA
98168
206-438-3356
PROJECT CONTACT
NAME
DAN HOGFOSS
PRIMARY PHONE
206-348-3381
MAILING ADDRESS 4308 S 131ST PL
dhoZ—MAIL oss@coscofire.com
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
TUKWILA
WA
98168
206-438-3356
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
MAI LING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I cert(jy 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: DATE
PRINT NAME: 0 Z'C'fy-
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application