16-105287NOV 0 2 2016
CITY OF FEDERAL WAY
CDS
0
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 +yermitcenter(dcitvoffederalway.com
PERMIT NUMBER /_�_ J O 5;k L 7 _ F P.
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
35405 23rd Ave Sw Federal Way
Bldg B
PROJECT VALUATION
$
ZONING
ASSESSOR'S TAX/PARCEL #
2 S Z l G
2,000
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING CX FIRE PREVENTION
NAME OF PROJECT
Waverly Community Fire Panel
Replace existing Fire Alarm Panel that got wet from painters. Install a
PROJECT DESCRIPTION
Nema 4 enclosure with a climate control heater and smoke detector with
Detailed description of work to
new Alarm Panel.
be included on this permit only
NAME
PRIMARY PHONE
Puget Sound Properties LLC
253 573 0133
MAILING ADDRESS
E-MAIL
PROPERTY OWNER
P.O Box 111882
CITY
Tacoma
STATE
Wa
ZIP
98411
NAME
PHONE
Fire King of Seattle
2067634177
MAILING ADDRESS
juS in@firekingofseattle.
240 S. Holden St
CONTRACTOR
CITY
STATE
ZIP
FAX
Seattle
WA
98108
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
FIREKKS89OCZ
i 7 i 17
20 13 101831 00
NAME
n "
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
Justin Gizinski
PRIMARY PHONE
253 359 5063
PROJECT CONTACT
MAILING ADDRESS
240 S Holden St
E-MAIL
Tustin firekin ofseattle.
(The individual to receive and
respond to all correspondence
CITY
Seattle
STATE
WA
ZIP
98108
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $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 ci as apart of this application.
I�
SIGNAT "` - �J DATE
PRINT N
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Bulletin #100 —January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
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