22-105935-Application-12.28.22CITY OFVZN�61 PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
PERMIT NUMBER — �ARGTrT DATE
22- 105935-SF - 1/23/2023
SITE ADDRESS
SUITE/UNIT #
122 S 357th St Federal, Way WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 21,359.40
1140000060 -
TYPE OF PERMIT
11
yJ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
122 S 357th
Voluntary repair to existing foundation
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
Nhu Le
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
122 S 357th St Federal, Way WA 98003
CITY
STATE
ZIP
NAME
PHONE
RAM Jack West/ Nikkie Grissom
541-520-3690
MAILING ADDRESS
E-MAIL
CONTRACTOR
Po Box 11701 Eugene Or, 97440
Permits@ramjackwest.com
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
RAMJAW*852PW
04 / 23
1603499720
NAME
PRIMARY PHONE
Same as Contractor
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
Same as Contractor
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ 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.
SIGNATURE: 1 ul/ d kxl DATE 12/27/2022
PRINT NAME: Nlkkle GriSSOC71
Bulletin #100 — February 19, 2020 Page 1 of 2 k:AHandouts\Permit Application