14-104429CITY OF
Federal Way
ELECTRICAL
PERMIT APPLICATION
FAM
PERMIT NUMBER A _ I v Q 4 Zq - 00
AUG 2 8 2014
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. 1 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 city as a part of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #160 — January 1, 2013 Page 1 of 2 k:\Ilandouts\Electrical Permit Application
IM
SITE ADDRESS: 204 S 348TH ST., FEDERAL WAY, 98003
CDS
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL #
CURRENT/PROPOSED USE
3784.32
2 0 2 1 0 4- 9 1 3 4
PROJECT NAME
(Tenant or Homeowner Last Name)
MAI TRI YOGA
REPLACE EXISTING FIRE ALARM PANEL WITH NEW POTTER PFC5004E.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAI TRI YOGA
( 253) 906 - 7573
MAILING ADDRESS
E-MAIL
204 S 348TH ST.
CITY
'STATEZIP
FAX
FEDERAL WAY
WA
98003
( ) -
NAME
PRIMARY PHONE
ALARM CENTER INC
( 800 ) 354 - 1555
MAMING ADDRESS
F-MAM
ELECTRICAL
PO BOX 3407
sanderson alarmcenterinc.c
CITY
STATE
ZIP
FAX
CONTRACTOR
LACEY
WA
98509
( ) -
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
ALARMC1055CW 02/ 16 / 15
20 -00 -101452 -00 -BL
NAME
PRMIARY PHONE
APPLICANT
SAME AS ABOVE
( 800 ) 354 - 1555
MAILING ADDRESS
E-MAM
SAME AS ABOVE
SAME AS ABOVE
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
SCOTT ANDERSON
PRIMARY PHONE
( 800) 354 - 1555
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. 1 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 city as a part of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #160 — January 1, 2013 Page 1 of 2 k:\Ilandouts\Electrical Permit Application
IM