15-101564RECEIVED
APR 012015 DEPARTMENT OF COMMUNITY DEVELOPMENT
WAY 33325 8a' Avenue South
CITY OF'-1. �' CITY OF FEDERALFederal Way, WA 98003-6325
CDS 253-835-2607; Fax 253-835-2609
Federal Way www,citvoff"ederalway.com
APPLICATION
CRITICAL AREA DIRECT SERVICES PROGRAM
Project Name:
Project Descri
Project Address: d & S P cvA 1 VowA-
M0V�Parcel #: 11- { L";70 0 A I
Contact Name:. { M ( Phone: 3 Q0';S(P- 0 q 1Email: JLtrytn 'G L 04 GW'"
Mailing Address (if different from above):
WA- ado Z�5
I am the owner of the above referenced property and I authorize the city to obtain an estimate of project cost. I recognize the
Direct Services Program is optional and that I may choose to utilize any qualified consultant of my choosing. I agree to
indemnify and release the city from all liability associated with the program or the work/reports of the consultant.
Signature`���J
Consultant Name:
Date Sent to Consultant:
Materials Sent to Consultant:
Y
❑ Site Plan
❑ Special Study(s)
❑ Other.
Bulletin #078 — June 1, 2014
City Use Only
❑ Landscape Plan
❑ Other:
Date: L
Folder #
Fee Estimate:
❑ Construction Drawings
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