21-103682-SF-APPLICATION-09-03-2021-V1CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 80, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcente ncityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 8,000.
TYPE OF PERMIT
X BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PARTITIONING FAMILY ROOM TO MAKE ONE BEDROOM / DECK & RAMP IN BACK / RAMP IN
PROJECT DESCRIPTION
FRONT.
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
MAINA NELLY
(862)336-3763
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
33712 40TH CT SW
neI1ymaina27n:gmaiIxom
CITY
STATE
ZIP
FEDERAL WAY
WA
98023
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
MAINA NELLY
f8621336-3763
APPLICANT
MAILING ADDRESS
E-MAIL
33712 40TH CT SW
nellymaina27jngmailxom
CITY
STATE
ZIP
FAX
FEDERAL WAY
WA
98023
NAME
PRIMARY PHONE
PROJECT CONTACT
NAIMA NELLY
(862)336-3763
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
33712 MOTH CT SW
nellvmaina27t maiixom
g
CITY
STATE
ZIP
FAX
concerning this application)
FEDERAL WAY
WA
98023
NAME
PROJECT FINANCING
MAINA NELLY
® OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
33712 40TI-I CT SW FEDERAL WAY, WA 98023
(862)-336-3763
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 lincluding 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 apart of this application.
SIGNATURE: DATE 8/27/2021
PRINT NAME: MAINA NELLY
Bulletin # 100 — February 19, 2020 Page. I of 2 k:\Handouts\Permit Application