12-104573�,troF L RECEIVO PERMIT
Federal Way
COMMUNITY DEVELOPMENT SERVICES O C T o 5p L I CAT I O N
253-835-2607• FAX 253-835-2609
www. cit uoffederalwau. rnm
CITY OF FEDERAL WAY
CDS
-CO
L O 5 1 1
MF CO ME PL DE END
/
CC c / J V
SITE ADDRESS
SUITE/UNIT M
515 312TH Street
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL M
2,200.00
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING x FIRE PREVENTION
NAME OF PROJECT
St Luke's Church
(Tenant Name/HomeoumerLast Name)
Replace FACP Dialer (DACT) with an AES Radio (DACR
PROJECT DESCRIPTION
Detailed description of work to
In both buildings. (2 radio's total
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
St Luke's Church
253-941-3000
MAILING ADDRESS 515 312th Street
E-MAIL
CITY Federal Way
STATE
ZIP 98003
WA
NAME Pacific Fire & Security Inc (Chris Rogers(
PHONE 206-957-0907
MAILING ADDRESS 828 Poplar PI S
E-MAIL
CONTRACTOR
chrisr@pacifiefiresecurity.com
CITY Seattle
STATE
ZIP 98144
FAX
WA
WA STATE CONTRACTOR'S LICENSE 0
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
PACIFFS914MF
12/31 /2012
20 06 103860-00-b1
NAME CONTRA OR
PHONE
APPLICANT
MAIL ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAM SAME AS CONTRACTOR
PHONE
(The individual to receive and
MAI G ADDRESS
EMAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
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 authorised 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 apart of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin 771 vu — January 1, 2u 1 1 rage 1 of s k:\Handouts\rermit Application