19-103839 RECEIVED
"�..... AUG (� (� PERMIT APPLICATION
AG
CITY OF ." •"•`•».•�.�,... O g 219
PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way
253-835-2607 + FAX 253-835-2609 + oerrmtcenteracttyoffederala•ay.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT `.�1}
PERMIT NUMBER l _ ! _02s 2 rj _ E /./
` t� LL TARGET DATE
SITE ADDRESS SUITE/UNIT it
35002 Pacific Hwy S Federal Way, WA 98003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL e
$ 1, 500 . 00 ` 9 5 a 9 5 - S
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT Federal Way Crossings Bldg. A
PROJECT DESCRIPTION Installing AES Radio.
Detailed description of work to
be included on this permit only
NAMEPRIMARY PHONE
C-Voc ,s , S
PROPERTY OWNER MAILING ADDRESS \/�/��•' EMAIL
u
CITY y ) STATE ZIP
NFire Systems West, Inc . 253-833-1248
MAILING ADDRESS EMAIL
206 Frontage Rd N, Suite-C servrce@firesys LemswesL coin
CONTRACTOR
CITY TE ZIP FAX
Pacific A 98047
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
FIRESWI055LW 12 / 31 / 19 19-87-000014-00-BL
NAME PRIMARY PHONE
Fire Systems West, Inc. 253-833-1248
APPLICANT MAILING ADDRESS E-MAIL
206 Frontage Rd N, Suite-C service@firesystemswestcorn
CITY STATE ZIP FAX
Pacific WA 98047
NAME PRIMARY PHONE
PROJECT CONTACT Matt Carlman 253-951-6005
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 206 Frontage Rd N, Suite-C mattc@firesystemswestcorn
concerning this application) PacificCITY STATE ZIP FAX
WA 98047
NAME
PROJECT FINANCING 0 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 cit a part of this application.
SIGNATURE: DATE 8/2/2019
PRINT NAME: Matt C rlman
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application