20-100913 RECEIVED PERMIT APPLICATION
CITY OF
Federal Way202,0 PERMIT CENTER+33325 8th Avenue South 4-Federal Way,WA 98003-6325
FEB 2 8 253-835-2607 4 FAX 253-835-2609+permitcente a, ityoffederalway.com
CITY OF FEDEF�AI-WAY
CpMMUNf1Y DEVELOPMENT
PERMIT NUMBER b- / a o 9 / 3 -
s7 TARGET DATE
SITE ADDRESS SUITE/UNIT#
505 S 336th St, Federal Way, WA 98003 suite 200&suite 330
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 23012
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT Mary Bridge
Add/relocate fire sprinklers at remodeled walls and ceilings
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
Mary Bridge Children's Heath Center (540)449-8772
PROPERTY OWNER MAILING ADDRESS E-MAIL
311 S L St
CITY STATE
Tacoma WZIP
98405
NAS PHONE
Columbia Fire
MAILING ADDRESS 1 1 1 S Findlay Street E-MAIL
CONTRACTOR
CITY STATE ZIP 98108 FAX
Seattle WA
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
COLUMFI952MG 12/ 31 / 20 20-09-100457-00-BL�
NAME Inna Burdeyna PRM12Util2.8569
APPLICANT
MAILING ADDRESS E-M111 S Findlay Street inna@columbiafire.net
CITYSeattle WA ZIP 98108 FA"(206).340.6100
PROJECT CONTACT NAME Inna Burdeyna (same as above) PRIMARY PHONE
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
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 Cit of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such clai , which may be made by any person,including the undersigned,and flied against the city,
but only where such a int arises out the reliance of the city, including its officers and employees, upon the accuracy of the
information suppli‘d to t city-as a p of this application.
SIGNATURE: ---- "' DATE Ooe/o78�izC3 oZ-O
PRINT NAME: /01//1/A e5z://007, /Uf/
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application