22-105600-Application-12.12.2241k
CITY OF
Federal Way
PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
35812 15th Ave SW Federal Way, WA 98023
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL # 7137800105
$ 15,798.43
-
TYPE OF PERMIT
12 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PRJ 1 13683;Belknap
Voluntary Foundation Underpinning; No change to existing footprint
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
Kay Belknap
253-927-4392
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
35812 15th Ave SW
casonsgrandma@yahoo.com
CITY
STATE
ZIP
Federal Way
WA
NAME
PHONE
TerraFirma Foundation S stems
206-888-1555
MAILING ADDRESS
E-MAIL
CONTRACTOR
761 NE Garden Valley Blvd
tacoma ermitsa oterrafirma. com
CITY
STATE
ZIP
FAX
Rosebura
OR
97470
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
TERRAFR931
06 / 30 22
NAME
PRIMARY PHONE
Brienna Ikerd - TerraFirma Foundation Systems
206-888-1555
MAILING ADDRESS
10111 S Tacoma Way
E-MAIL
tacomapermits@goterrafirma.com
APPLICANT
CITY
STATE
ZIP
FAX
Lakewood
WA
98499
NAME
PRIMARY PHONE
PROJECT CONTACT
Brienna Ikerd
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
10111 S Tacoma Way
CITY
STATE
ZIP
FAX
concerning this application)
Lakewood
WA
98499
PROJECT FINANCING
NAME
Kay Belknap
® 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 a of application.
part this
SIGNATURE: �� d"Ie l.GYi DATE 12/9/2022
PRINT NAME: Brienna Ikerd
Bulletin #100 - February 19, 2020 Page 1 of 2 k:AHandouts\Permit Application