19-104014 RECEIVED
ZIT„of ,�,,,,,,.• AUG 2 0 2019
PERMIT APPLICATION
PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal �e��/ COMMUNE p E WAy 253-835-2607+FAX 253-835-2609+permitcenter@cityoffederalway.com
EVELOPMEN.
PERMIT NUMBER -1 -`0 N O - 115-TARGET DATE
SITE ADDRESS `'�� �p/�n�_ I 1 SUITE/UNIT it
3znu AVG Jouui 1'Guciai 90 uy A. 98003- 3,2-o S , 3�3ict t
PROJECT VALUATION ZONING ASSESSOR'SSSTAX/PARCEL Y
$ 75783 2154650060, 2154650090, 2154650110, 2154650120
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING a FIRE PREVENTION
NAME OF PROJECT Davita Federal Way
PROJECT DESCRIPTION Fire Alarm for new 3 story office building
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
Davita Inc. 918.810.3700
PROPERTY OWNER MAILING ADDRESS E-MAIL
2000 16th Street
CITY STATE ZIP
Denver CO 80202
NAME Convergint Technologies PHONE 425-272-2250
MAILING ADDRESS 450 Shattuck Ave S. dave lark@convergint.com
CONTRACTOR
CITY Renton WATE � 98057 FAX 425-251-0949
WA STATE CONTRACTOR'S LICENSE if EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE i
CONVETL984BQ 1/1$12020, 20-05-102938-00-BL
NAME PHONE
Convergint Technologies X425-272-2250
APPLICANT MAILING ADDRESS E-MAIL
450 Shattuck Ave S. dave.clark@convergint.com
CITY Renton STATE ZIP FAX
WA 98057 425-251-0949
PROJECT CONTACT NAME ONE
Dave Clark
PRIMARY
53 691 4609
(The individual to receive and MAILINGADDRESS
Shattuck Ave S. E-MAILdave.clark@convergint.com
respond to all correspondence
concerning this application) CITY Renton In
ZIP 98057 FAX 425-251-0949
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 authorised 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 t the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regu ting
construction or environmental laws.
Ifurther 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 apart of this application. /
, _ A
SIGNATURE: /__
DATE t/7- t d7
PRINT NAME: PrkS i `fi-1.44e41.-
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application