19-104860 ,may, • RECEIVED PERMIT APPLICATION
CITY OF
OCT 01 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way 253-835-2607+FAX 253-835-2609+permitcenteracitvoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER _ 1 D b _ J
TARGET DATE
SITE ADDRESS SUITE/UNIT#
32275 32nd Ave S Federal Way WA. 98001
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3721.00 2154650080 _
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING IN FIRE PREVENTION
NAME OF PROJECT Davita CRAC-21 Motorized Damper
Install 1 relay for control of Motorized Damper
PROJECT DESCRIPTION
Detailed description of work to South K i Fire fa. Rescue
be included on this permit only &
Approved
Ac
NAME 0 Subjeolt_tQ attached details PRIMARY PHONE
Davita Inc. 918-810-3700
PROPERTY OWNER MAILING ADDRESS By—
E-MAIL
2000 16th Street10/3-in
IPolDenver Date _—`_sT 280202
NAME PHONE
Convergint Technologies 253-691-4609
MAILING ADDRESS E-MAIL
CONTRACTOR 450 Shattuck Ave S dave.clark@convergint.com
CITY STATE ZIP FAX
Renton WA 90857 425-251-0949
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CONVETL984BQ 1 /18 X2020 20-05-102938-00-BL
NAME PRIMARY PHONE
Convergint Technolgies 425-272-2250
APPLICANT MAILING ADDRESS E-MAIL
450 Shattuck Ave S dave.clark@convergint.com
CITY STATE ZIP FAX
Renton WA 98057 425-251-0949
NAME PRIMARY PHONE
PROJECT CONTACT Dave Clark 253-691-4609
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 450 Shattuck Ave S dave.clark@convergint.com
concerning this application) CITY STATE ZIP FAX
Renton WA 98057 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 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 city as a part of this application.
SIGNATURE: ), DATE JO/7
/,4
PRINT NAME: l Q L-
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application