22-104525-Bldg Permit Application-10-03-22arr Ew
Federal Wy
PERMIT APPLICATION
PEIRWRT CEMER + 33325 86 Avenuc Soutb + l=edvral Way, WA 98003-5325
253-a35-2607 + FAX 2-534� 5-2609 + perzpitcenitif{ t}offedera.lwuv.com
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TYPE OF PERAUT
BUJJD]Nry ❑ PLURU iN(� Ah1 CHAMCAL El DEmounoN U BNGMM;' W. El FIRE PR3+ T.NTFOY
NAME OF PROJECT
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i rertifq Leader penaUF 4f per tzar ! am the property owner or authvrfirM agent of the pmperty oamlrr Y [c7lifir beat to the brsk
of My 17;oW U*e, the lR VrM41[014 jrrbraittkd irk SUppart of this pvr Wt RppHcaltioa Is truE and 6[}rrwL I certib that ! Mitt cmply uith
a!t applL-able CYty of FcdiraL Way rrgulatkuts prr#a&Crtp to the work aathorimrd by tha f &uAftee of a pe mit. I andaratari Yfegl the
tmuance of this permit doe# ant m"ve the ourner's rcxpo"4p-bU ty f w c*o3pHafeCe rbkh loaalr state, or federal laum regulat?ng
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i further agree to hotel harmless the City Pf Fadrra[ Way as to any claim "cfudfrsg avfta, ez see, sad attorneys' fees jnc�tr+'ed in
the ireuas[igatioY� t:rui dtfwuee OfsuClk leiitnr, eulhick IR¢y Z+C IRQitGby only Fk7lr}rt, 13ut ding the uycderaigned, anddied against the city,
but only wh, au&h 42mdo[ aAmea out of the naian= of the city, is uding Us Office7S and &rnFfoyee-s, upon the arcra•ary of tfw
jnf� lion jtuprtl#f to tP*A e4t1y a;r a p,sr[ of this app[➢c 6ai
SIGNATURE- i l � -It.6 DATE
PP NT NAME:
BuBe in 9100 — February 19, i020 Page 1 of 2 k-%Handouts%Perm t Apphculim
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NIF.CHANTCAI PERMrr
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GENERAL INFORMATION
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RESIDENTIAL -NEW OR ADDITION
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