15-105214 t t
' firEIVED •
CITY OF Alb. OCT 13 2015 PERMIT APPLICATION
Federal Way
CITY OF FEDERAL WAY
CDS P
PERMIT NUMBER 5 _ I b 5 / _ TARGET DATE
SITE ADDRESS SUITE/UNIT#
1066 S 320th St Federal Way WA — 2653
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 141,245.63 0 8 1 0 - 9 1 8
TYPE OF PERMIT ❑BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ENGINEERING RI FIRE PREVENTION
NAME OF PROJECT High Point
Install Underground Fire line
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER High Point 320 LLC 425-453-9551
MAILING ADDRESS E-MAIL
10900 NE 8th Street Suite#1200
CITY STATE ZIP
Bellevue WA 98004
NAME PHONE _.. -....._.
Lloyd Enterprises Inc 253-874-6692
MAILING ADDRESS E-MAIL
CONTRACTOR PO Box 3889 jeffw@lloydenterprisesinc.com
CITY STATE ZIP FAX
33'1q Federal Way WA 98063 253-838-0103
1 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
LLOYDI*238QB Q4 / 15 /2017 20-00-102138-OOBL
NAME ..... PRIMARY PHONE -.
Lloyd Enterprises Inc(Jeff Washington) 253-835-6615
APPLICANT MAILING ADDRESS E-MAIL
^ G/J PO Box 3889 JeffW(a�lloydenterprisesinc.com
�-/ 1 ) 11 /3 CITY STATE ZIP FAX
r/1_'^l� V VFederal Way WA 98063 253-838-0103
NAME PRIMARY PHONE
PROJECT CONTACT Lloyd Enterprises Inc(Jeff Washington) 253-835-6615
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence PO Box 3889 JeffW@Iloydenterprisesinc.com
concerning this application) CITY STATE ZIP FAX
Federal Way WA 98063
__ NAME _._ ..
PROJECT FINANCING High Point 320 LLC I OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
IRCW 19.22.095) 10900 NE 8th Street Suite 1200 425-453-9551
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. f
SIGNATURE: _ DATE /L'--1. --/i
PRINT NAME: Lloyd Enterprises I c(Jeff Washington
Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application