21-102015-Building 29 Permit ApplicationC$TY Of
Federal Way
PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcerlter(u cityoffederalway.corli
TARGET DATE
SITE ADDRESS
SIIITE/UXrr #
2-7 Si 9XX FEWC& GVAV b1 A
PROJECT VALUATION
ZONING
ASSESSOR'S TA%/P CEL #
$ E02
—
TYPE OF PERMIT
IVl BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 1-1 ENGINEERING ❑ FIREPREVENTION
NAME OF PROJECT
SUILWA16 Z FI
PROJECT DESCRIPTION
Detailed description of work to
- I i - O MA6 6-6
�-
A G NA Same- n _ i &Nh S i 1
be included on this permit only
PROPERTY OWNER
NAME
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PRIMARY PHONE
2, q- i Z
MAIL O ADnRE&S
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E-MAIL
CITY STA ZIP
56krLLC I WA
NAME
ctil a - r<
PHONE
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NAMING ADDRESS /�
E-MAIL
CONTRACTOR
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Z
FAN
FAX
WASTATE CONT TOR'SnyLIICENSE #
CMac?"' a
ERPIRAT(IOwN DATE
/ lw
UBI #
O -22-7-
NAME
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PRIMARY PHONE
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M i H.iNG ADDRESS CrJ
E-MAIL
,
APPLICANT
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FAX Al ANAME
PROJECT CONTACT
K10i
PRIMARY PHON
42S'-3$ E -3r�'
MAILING AD RESS
47J
E-MAIL
(The individual to receive and
respond to all correspondence
CITY L7ATzzP
q U C.
1
PAx
qJ1A
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When ualue is $5, ODD or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 t as apart of this application.
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SIGNATURE: DATE 91 �Jt 2o2
PRINT NAME:
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Bulletin #100 - February 19, 2020 Page l of 2 1<:111andoutsllonnit Application