21-104419'RECEIVED
.4s, OCT 20 ZU21 PERMIT APPLICATION
CITY OF
CITY OF FEDERAL WAY PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way COMMUNITY DEVELOPMENT 253-835-2607 + FAX 253-835-2609 + permitcentel<�cityoffederalway.com
PERMIT NUMBER � C I _ / 49 Y_ � I — S
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
29 S 342nd Place, Federal Way, WA 98003
A,B, C & D
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$
RM2400
1 3 2 2 0 2- 0 6 7 0
TYPE OF PERMIT
IN BUILDING ❑ PLUMBING ❑MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Panther Lake Apartment Fire - Damage Inspection
Damage in section to units A, B, C & D due to fire damage.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PLOVER LLC
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
29 S 342nd Place
E-MAIL
CITY
STATE
ZIP
Federal WayWA
98003
NAME NW Builder Group LLC
PHONE 253-236-8319
MAILING ADDRESS
8228 South 206th Street
E-MAIL
justin@nwbuildergroup.com
CONTRACTOR
CITY Kent
WA
z>p 98032
FAx
WA STATE CONTRACTOR'S LICENSE #
NWBUIBG838NP
EXPIRATION DATE
09 i 13 i 23
UBI # 604151204
NAME
Jesse Binford
PRIMARY PHONE
253-833-5557
APPLICANT
MAILING ADDRESS
3605 C St NE
E-MAIL
jbinford@bcie.net
CITY
Auburn
STATE
WA
ZIP
98002
FAX
253-833-7309
NAME
See Applicant
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME n/a - insured loss
❑ OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 apart of this application.
Ysigned hyJesse1 9B[CrtIonrd sslgal+vc Englnecfc ou,
Jesse L Blnford
use10-20-21
SIGNATURE: _ WIe:7R2i IQ,zoo�ss:a4.07V0 DATE
T
Jesse Binford
PRINT NAME:
Bulletin #100 —February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application