21-104259-SF Deck Permit Application 11-5-2021-V141k
CITY 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 + permitcenteracityoffederalway.com
- r d
1 ?--!E 4 - TARGET DATE '
SITE ADDRESS SUITE/UNIT N
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL M
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
f _
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MPJLING AD RESS
E-MATT
-77
CITY
14- -1LLaw A
STATE ZIP
I W& 9 g
NAME
C, KLi J.I"`�Vv�
PHONE
MA{L1NNG-ADDRE
E-MAIL
CONTRACTOR
CITY F ` �
STATE
kAX
WA STATE CONTRACTOR'S LICENSE k
EXPIRATION DATE
094
NAME; _ j
PRIMAR(PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME ji�{�f�
S - J ' �
PRIMARY PHONE
6 —'f �
PROJECT CONTACT
1 1a
13' ^ 919
MAILING ADDRESS
1) t°-.;,
E-MAIL
(The individual to receive and
respond to all correspondence
CITY q,
STATE
Z
concerning this application)
PROJECT FINANCING
NAME
- i . +
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW19.27.095J
MAILIN ADDRESS, CITY STATE, ZIP
r7 2-j (1,,,r�� wvt- S'rag.3
PHONE
,�-`iZ _ c. Wit✓
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 tincluding costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claimJ, 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.
7
SIGNATURE: DATE I
PRINT NAME: 4A
Bulletin #100 -February 19, 2020 Page l of 2 k:lHandoutslParmit Application
CITY OF
Federal Way
Project Name Svv
DEPARTMENT OF COMMUNITY DEVELOPMENT
33325 8'h Avenue South
Federal Way, WA 98003-6325
253-835-2607; Fax 253-835-2609
www.citvoffederalway.com
I acknowledge that the above required documents/plans contain all the listed information.'
Initials
I acknowledge that each PDF document submitted will meet the following naming sequence: File ID
Number —Document Name -Submittal Date -Version Number (V3).
�] 20-102126-0uilding Permit Application-05-02-202D41
Example N, 20-I02126 Planset-06-D2-2D20-VI
20-102226-Specifications Sheets-06-02-2020-Vl Initials
File # —
Intake by:
Date:
STAFF USE ONLY
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Bulletin #156—Apri 127, 2021 Page 4of4 k:\Handouts\Residential-Remodel Checklist