18-10510640k
CITY OF
Federal Wary
PERMIT NUMBER 12 -
RECEIVED PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
OCT 3 U 2018 253-835-2607 + FAX 253-835-2609 + permitcenter(dcitvoffederal«'ay.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
�0 S /0- �C_10
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
33020 1 Oth Ave SW Fe cral Way, WA 98023
BLDG T
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 2500.00
0 5 -
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
Latitude Condominiums- Fire Panel Replacement
Replacement of GE Fire Shield FS502 Fire Panel due to failure.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME Latitude Condominiums
PRIMARY PHONE
253-840-1200
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
PO BOX 4579
conniec@asofwa.com
CITY
Houston
STATE
TX
ZIP 77210
NAM
Ivergreen
P ONE
Fire & Security
253-627-7561
MAILING ADDRESS
2111 S 90th Street
E-MAIL
service@evergreenfire.com
CONTRACTOR
CITY
STATE
ZIP
FAX
Tacoma
WA
98444
WASTATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
602036117 Lic # EVERGFA979P7 �I(
12/ 31 /18
20-12-102201-OOBL
NAME
PRIMARY PHONE
Evergreen Fire & Security
253-627-3794
APPLICANT
MAILING ADDRESS
2111 S 90th ST
E-MAIL
service@evergreenfire.com
CITY
STATE
ZIP
FAX
Tacoma
WA
98444
NAMEAmyg Ogren -Bedford
PRIMARY PHONE
253-625-7561
PROJECT CONTACT
MAILING ADDRESS
2111 S 90th St
E-MAIL
service@evergreenfire.com
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
Tacoma
WA
98444
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 c1 ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplieldythe ity as apart of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 - January 29, 2016 Page] of 2 k:\Handouts\Permit Application