95-101568CITY OF FEDERAL WAY PERMIT NO: BLD95 -0528
33530 First Way South BUILDING PERMIT ISSUED: 07/25/95
Federal Way, WA 98003 Building Inspection Requests 661 -4140 BY: KLC
661 -4000 EXPIRES: 07/25/96
ADDRESS:602 SW 316TH ST
NO.: 555920 -0185
PROJECT DESCRIPTION:RES ADDITION - 432 SOFT ADDITION OF LIVING AREA TO EXISTING RESIDENCE.
= OWNER _ _______ ___ _______ __ __________________________ CONTRACTOR
RICK DENSMORE# OWNER IS CONTRACTOR # ##
602 SW 316TH ST
FEDERAL WAY WA 98003
839 -3962
* ** NONE * **
LENDER== = = = = ==
OWNER IS LENDER
------------------------------ --------------------------------------------------------------------------------------------------------- - - - - -- - - -- ------------------
Sts CONTRACTORS, PLEASE USE LOCATION CODE 1132 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE : 8.2t M
BLD?:X MEC ?:X PLM ?:X FLR -- EXIST -- PROP- -- DWELLING UNITS: 1 COMP PLAN ......... :SR FEES:
TYPE OF WORK:ADD USE:RES 1ST.: 854: 390:sf STORIES........: 2 REQUIRED PARKING..: 2 SPRINKLERS ?......:? PLAN CHECK FEE $ 325.00
CENSUS CATEGORY ..... :434 2ND.: 784: 42:sf HEIGHT.....: 0.00 ft HAZARD CLASS...:? FINAL PLAN CHECK ... # $ -140.08
OCCUPANCY GROUP---- - - - - -- 3RD.: 0: O:sf VALUATION---- - - - - -- REQUIRED SETBACKS- - -- - -- FIRE FLOW....: 0 gpe BUILDING PERMIT....* $ 284.50
:R3 :? OTHR: 0: O:sf EXIST..$: 59800 FRONT.........: 30.00 ft SBCC SURCHARGE.....* $ 4.50
TYPE OF CONSTRUCTION - - - -- BSMT: 0: O:sf PROP ...$: 29614 SIDE..........: 5.00 ft WATER SERVICE..:FED MEC APPLIANCE FEES.* $ 27.50
:5N : : DECK: 224: 228:sf REAR..........: 25.00:ft SEWER SERVICE..:FED PLUMBING FIXT .... 93* $ 28.00
OCCUPANT LOAD------ -- -- -- GAR.: 768: O:sf RECEIVED.:07 /12/95 PUB WKS PLCK(SF)..93 $ 40.00
0: 0: 0: 0: TOTL: 2630: 660:sf IMPERV SURFACE: 4776 sf SENSITIVE AREAS ?.:Y
#FURN<IOOK..: UEL TYPES. :GAS ELE FANS..........: 1 BOILERS /COMPRESSORS WATER CLOSETS......: 1 URINALS........: 0 TOTAL FEES $ 569.42
AS PIPING.: 0 ft HOOD..........: 0 0-3 HP......: 0 BATH TUBS..........: 2 DRINKING FOUNT.: 0
1 DUCT WORK...... 1 3 -15 HP...... 0 SHOWERS ............. 0 SUMPS........... 0
GAS HWT .... : 1 WOOD STOVES...: 0 15-30 HP....: 0 LAVATORIES.........: 1 VAC BREAKERS...: 0
CONY BURNER: 0 FURN>lOOK...... 0 30-50 HP..... 0 SINKS ............... 0 DRAINS.......... 0
BBO ........ . 0 MISC........... 0 5+ HP........ 0 DISH WASHERS........ 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS--- - - - - -- ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0
RANGE......: 0 <: 10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORT( IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE IMF TIO NISHED BY ME IS TRUE AND CORRECT TO THE REST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL NAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT _ DATE _ 71ZrS_}�
FILE COPY
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CITY OF FEDERAL WAY
33530 First Way South
Federal Way, WA 98003
661 -4000
<BUILDING PERMIT ISSUED: 07/25/95
Building Inspection Requests 661 -4140
ADDRESS:602 SW 316TH ST
NO.: 555920 -0185
PROJECT DESCRIPTION:RES ADDITION - 432 SQFT ADDITION OF LIVING AREA TO EXISTING RESIDENCE.
�= OWNER - ---- - - ----- ._..: = CONTRACTOR = — - -M= - --- -- ----
RICK DENSMORE ' M. D. ELECTRIC
602 SW 3161H ST 1815 S. 266TH PL.
FEDERAL NAY WA 98003 KENT WA WA 98032
IV-3962
BLD ?:X NEC ?:X PLM ?:X
TYPE OF WORK:ADD USEAES
CENSUS CATEGORY ..... :434
OCCUPANCY GROUP--------- -
:R3 :?
TYPE OF CONSTRUCTION--- --
:5N .
OCCUPANT LOAD ------------
. 0: 0: 0: 0:
FUEL TYPES.:GAS ELE
GAS PIPING.: 0 ft
N<100K..: 1
HUT..... 1
CONV BURNER: 0
HBO......... 0
GAS DRYER..: 0
RANGE....... 0
GAS LOGS...: 0
FLR-- EXIST -- PROP ---
1ST.: 854: 390:sf
2ND.: 784: 42:sf
3RD.: 0: O:Sf
OTHR: 0: O:Sf
BSMT: 0: O :Sf
DECK: 224: 228:sf
GAR.: 768: O:Sf
TOTL: 2630: 660:Sf
FANS..........: 1
HOOD........... 0
DUCT WORK.....: 1
WOOD STOVES...: 0
fURN>lOOK ..... : 0
RISC........... 0
AIR HANDLING UNITS
<: 10,000 CFM: 0
> 10,000 CFM: 0
559 -3039
MDELE * *055BQ
DWELLING UNITS: 1
STORIES......... 2
HEIGHT.....: 0.00 fit
VALUATION ----------
EXIST..=: 59800
PROP...:: 29614
RECEIVED.: 07 /12/95
BOILERS /COMPRESSORS
0-3 HP....... 0
3-15 HP.....: 0
15 -30 HP....: 0
30-50 HP....: 0
5+ HP........ 0
FUEL TANKS-------- -
ABOVE GROUND: 0
UNDERGROUND.: 0
COMP PLAN ......... :SR
REQUIRED PARKING..: 2
REQUIRED SETBACKS -------
FRONT ......... . 30.00 ft
SIDE........... 5.00 ft
REAR........... 25. DO: ft
PERMIT NO: BLD95 -0528
BY: FC2
EXPIRES: 07 /09/97
RENEWED PERMIT
LENDER
OWNER IS LENDER )
)
)
i
SPRINKLERS ?......:?
HAZARD CLASS...:'.
FIRE FLOW....: 0 9Ps
WATER SERVICE..:FED
SEWER SERVICE..:FED
INPERY SURFACE: 4776 Sf SENSITIVE AREAS ?.:Y
WATER CLOSETS......:
1
URINALS........: 0
BATH TUBS..........:
2
DRINKING FOUNT.: 0
SHOWERS .............
0
SUMPS........... 0
LAVATORIES.........:
1
VAC BREAKERS...: 0
SINKS ...............
0
DRAINS.......... 0
DISH WASHERS.......:
0
LAWN SPRINKLERS: 0
ELEC MIR HEATERS...:
0
OTHER FIXTURES.: 0
LAUN MSHR OUTLTS...:
0
FEES:
PLAN CHECK FEE $ 325.00
FINAL PLAN CHECK ... = $ -140.08
BUILDING PERMIT....* S 284.50
SBCC SURCHARGE.....* $ 4.50
NEC APPLIANCE FEES.* $ 27.50
PLUMBING FIXT .... 93* $ 28.00
PUB MKS PLCK(SF)..93 $ 40.00
BUILDING PERMIT....* $ 71.13
TOTAL FEES S 640.55
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMAT FURNISED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT _ _ .__._ _
- - - ..- ----------------- _____-.________------ - - - - -- DATE
FILE COPY
�CITY OF t L.Df..RAt- WAY
-93530 first Way South
Federal Way, WA 98003
661-4000
<BUIL-DINC, PERMIf ISSUED: 01/25/95
Building Inspection Requests 661-4140
ADDRESIE,:602 SW 316TH SI
NO.: 555920-0185
PIIOJL(-f DESCRIPTION:AES 4001flON - 432 SQfl ANIIIOW Of LIVING AREA 10 EXISTING RESIKKI.
OWR (QKIR4(IOR �-v
RICK KNMI N. 0- CLIORIC
602 SIN 3161N !rjl 1915 S. 1116b19 pt.
FEKRAI WAY WA 9W3 KINI VA VA 9WR
559-3m
"DFLE410SIX11
1,5-, lot 574Y
PERMIT NO. t3LD95--0528
BY: I:C2
EXPIRL--S: 07/09/97
REHEWED PERMIlk
-Fw AV-
ROI I'Vo
711
IBLP?:X KC?:X PtN?:X COMO PLAN ......... :Sk FEES:
foulklo PARKINC.. - 1 wittlits? ...... :? PLAN C*Ct FEE
TYPE 01 WRKADD tISEAES ]ST.: 854: 3-wsu-i-F t.
CLAIMS CATEGORY ..... :434 21110.: '184: 42: cal. HAZARD CLASS...:? j FIK PLAN CRECK-4
OC(UPAKY 310.. 0: WILDING PERRI I....
:93 010. 0- 0-SU UISIA. 51jow SKC SmCNAU.....
Pow— 1. 214114 JAKE f EES.
IVPF of (OffsIAUClION- rAl 1 0. 0:;f' I I ( f 1XI .... Iris
K10 MKS PLCK(Sf)..?3
OCCUPANT tow vo-
i"I'll
1 0: 0- 0: 0: ;ii,1*1-k11A v SURFACE 41'16 st SENSITIVE ANIV.1 Bull DING PcR"I I....
3*15.00
440.08
204.50
4.50
21.50
28.00
40.00
11.13 ■
w
I'lift lypES.AAS 1:11 fms'�" 801LIRSICOMPkESSORS WATER CLOSETS.... . I mWLS ........ 0 [MAL ffts "0. 55
210? 0
...... U-3 DP ...... : 0 VAIN TUNS .......... 2 MINING FOUNT.: 0
PIAS PIPING.: 0 ft
N000K. -: I DOC I WORK.....: 1 3-15 NP.....: 0 SHOM ............. 0 SINUS..........: 0
NMI....: 1 0000 VOWS—. 0 15-30 W....: 0 tAVAIORIES ......... : I VAC MEAKEIS ... : 0
(011y AwNt'l: 0
: 0 30-50 UP—.: 0 SINKS ...... ....... : 0 DRAINS.........: 0
......... 0 RISC..........: 0 5# 4P.......: 0 PIA VASIII"s ....... : 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR RANKING UNITS It►tt TANKS---- -__ -_- fLIC Wig NIAIERS ... : 0 OTHER FIXTURES.: 0
RAN[ ...... 0 (40'Ift ff": 0 ABOVI (.ROUND: 0 l(AIN WOR OUIUS ... : 0
GAS tOGS-.: 0 > 10,000 (IN: 0 UNKRCRMD.: I
PERMITS
EAVIRL IIXI !;, MILK I,).AfftWL tr WU WW& 175 SIATtTLD. RUIULN1IAl MI TRADING FLKIII 15 LAVIKE M JIM ALIEN DAII Ut 1'3b'JHRtt-
I CERTIFY THAT IN[ INFORRA11tORNISID RY W IS IRVI AND (ORRLCI TO IKE REST Of NY KMIla AND 1111f APPLICABLE CIIY Of fERERAI. WAY RIOUIRLNENIS Will of 41 -
V n UR AGENT VH I L
V,
FIELD COPY
OWNER IS 11.1111WR
-Fw AV-
ROI I'Vo
711
IBLP?:X KC?:X PtN?:X COMO PLAN ......... :Sk FEES:
foulklo PARKINC.. - 1 wittlits? ...... :? PLAN C*Ct FEE
TYPE 01 WRKADD tISEAES ]ST.: 854: 3-wsu-i-F t.
CLAIMS CATEGORY ..... :434 21110.: '184: 42: cal. HAZARD CLASS...:? j FIK PLAN CRECK-4
OC(UPAKY 310.. 0: WILDING PERRI I....
:93 010. 0- 0-SU UISIA. 51jow SKC SmCNAU.....
Pow— 1. 214114 JAKE f EES.
IVPF of (OffsIAUClION- rAl 1 0. 0:;f' I I ( f 1XI .... Iris
K10 MKS PLCK(Sf)..?3
OCCUPANT tow vo-
i"I'll
1 0: 0- 0: 0: ;ii,1*1-k11A v SURFACE 41'16 st SENSITIVE ANIV.1 Bull DING PcR"I I....
3*15.00
440.08
204.50
4.50
21.50
28.00
40.00
11.13 ■
w
I'lift lypES.AAS 1:11 fms'�" 801LIRSICOMPkESSORS WATER CLOSETS.... . I mWLS ........ 0 [MAL ffts "0. 55
210? 0
...... U-3 DP ...... : 0 VAIN TUNS .......... 2 MINING FOUNT.: 0
PIAS PIPING.: 0 ft
N000K. -: I DOC I WORK.....: 1 3-15 NP.....: 0 SHOM ............. 0 SINUS..........: 0
NMI....: 1 0000 VOWS—. 0 15-30 W....: 0 tAVAIORIES ......... : I VAC MEAKEIS ... : 0
(011y AwNt'l: 0
: 0 30-50 UP—.: 0 SINKS ...... ....... : 0 DRAINS.........: 0
......... 0 RISC..........: 0 5# 4P.......: 0 PIA VASIII"s ....... : 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR RANKING UNITS It►tt TANKS---- -__ -_- fLIC Wig NIAIERS ... : 0 OTHER FIXTURES.: 0
RAN[ ...... 0 (40'Ift ff": 0 ABOVI (.ROUND: 0 l(AIN WOR OUIUS ... : 0
GAS tOGS-.: 0 > 10,000 (IN: 0 UNKRCRMD.: I
PERMITS
EAVIRL IIXI !;, MILK I,).AfftWL tr WU WW& 175 SIATtTLD. RUIULN1IAl MI TRADING FLKIII 15 LAVIKE M JIM ALIEN DAII Ut 1'3b'JHRtt-
I CERTIFY THAT IN[ INFORRA11tORNISID RY W IS IRVI AND (ORRLCI TO IKE REST Of NY KMIla AND 1111f APPLICABLE CIIY Of fERERAI. WAY RIOUIRLNENIS Will of 41 -
V n UR AGENT VH I L
V,
FIELD COPY
.................. _...................
............. ...............................
................. _ .. _ .............
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R'A!1fS'iF WINGS
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CDO193
-'CITY OF FEDERAL WAY
33530 First Way South
Federal Way, WA 98003
661 -4000
U I LDI N
Building Inspection
PERMIT
Requests 661 -4140
ADDRESS:602 SW 316TH 5T
NO.: 555920 -0185
PROJECT DESCRIPTION :RES ADDITION - 432 SOFT ADDITION OF LIVING AREA TO EXISTING RESIDENCE.
OWNERas==... CONTRACTOR uama .... == ....... ..........
RICK DENSMORE * ** OWNER IS CONTRACTOR * **
602 SW 316TH ST
FEDERAL NAY WA 98003
39 -3962
* ** NONE * **
LENDER= =- =m.
OWNER IS LENDER
PERMIT NO:
ISSUED:
BY:
EXPIRES:
BLD95 --0528
07/25/95
KLC
07/25/96
=s* CONTRACTORS, PLEASE USE LOCATION CODE 1732 VHCN REPORTING SALES TAX FOR PROTECTS NITNIN THE CITY OF FEDERAL WAY. TAX RATE : 8.2; M
asa=: samaa= m= a= msmax:s =srcassvu =t•aca =.ar.�:zm axas:am =�aa:sa = °x.a� =° .. _.- .e.f »�aala� assaaaaca. a ..a.se.amssaaamn::aarts=mraa =s =e sa=mae.aam�mcma. aa<zm=aaaacaa.saamsa =ac =.aa:�
BLD ?:X MEC ?:X PLM ?:X FLR -- EXIST - -PROP- -- DWELLING I'NTTS: .1 COMP PLAN ......... :SR FEES:
TYPE OF WORK:ADD USE:RES 1ST.: 854: 390:sf STORIES.....:..: 2 REQUIRED PARKING..: 2 SPRINKLERS ?......:? PLAN CHECK FEE
CENSUS CATEGORY ..... :434 2ND.: 784: 42:sf HEIGHT.....: 0.10 ft HAIARD CLASS—;? FINAL PLAN CHECK...*
OCCUPANCY GROUP---- - - - - -- 3RD.: 0: O:sf VAL.UATIOH - - -- - - - -- RFOUIRED SETFAIL;- -- -- FIRE FL9W....: J 9TH BUILDING PERMIT....*
:R3 :? OTHR: 0: O:sf EXISTA. 59800 FRONT.......... 30.00 ft SPCC SURCHARGE.....*
TYPE OF CONSTRUCTION - - - -- BSMT: 0: O:sf, PROP.., ;: 29614 SIDE..........: 5.00 ft WATER SERVICIE- JED NEC APPLIANCE FEES.*
:5N ^ECh: 224. 228:6f REAR..........: 25.00:ft SEWER SERVICE..:FED PLUMBING FIXT .... 93*
OCCUPANT LOAD-- -- ---- -- -- GAR.: 768: 9 :5f RECEIVED. :01/12/95 PUB WKS PLCK(SF)..93
0: 0: 0: 0: TOTS: 2630: 660 a f IMPERV SURFACE: 4776 sf SENSITIVE AREAS ?.:Y
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FUEL TYPES.:GAS ELE FANS..,,'.....: 1 BOILERS /COMPRESSORS WATER CLOSETS......: 1 URINALS........: 0 TOTAL FEES
S PIPING.: 0 ft HOOD..........: 0 0 -3 HP ...... 0 BATH TUBS..........: 2 DRINKING FOUNT.: 0
JRN<100K..: 1 DUCT WORK.....: 1 3 -15 HP.....: 0 SHOWERS ............: 0 SUMPS..........: 0
GAS HWT....: 1 WOOD STOVES...: 0 15 -30 HP....: 0 LAVATORIES.........: 1 VAC BREAKERS...: 0
CONY BURNER: 0 FURN>100K.....: 0 30-50 HP....: 0 SINKS ..............: 0 DRAINS.........: 0
BBQ ........ : 0 MISC..........: 0 5+ HP ....... 0 DISH WASHERS.......: 0 LAWN SPRINKLERS: 0
GAS PRYER..: 0 AIR HANDLING UNITS FUEL TANKS--- - - - - -- ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0
RANGE......: 0 < :10,000 CF": 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
... _sxm ^ - -a cis.:. ,- _z.-asxaa emacaaazmsx= smmyr.... —. R a ...=.n.. .....= a... . ... I — =.... aeaa:smaF
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE If WO WORK IS STARTED. RESIDENTIAL. AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY TWAT THE INF II"NISNED BY ME IS TRUE AND CORRECT TO TIN: NEST OF NY KNOWLEDGE AND THE APPLICANLE CITY OF FEDERAL WAY REQUIREMENTS WILL IF LET.
OWNER OR AGENT _ _ DATE
FIELD COPY
325.00
-140.08
284.50
4.50
27.50
28.00
40.00
S 569.42
CDO193
�OF G City of Federal Way
FAZ APPLICATION FOR BUILDING PERMIT
JUL 12 05 -1 It
vF FEDERAL WAY L/ 1T kD
PLEASE PR /NT p}pdG DEPT*
APPL /CAT /ON #: tj- Lc�-Z&—_
SITE LOCATION Address
4?0 z 162 St
Tenant (if known) _I Lot # Assess
/�i or's Tax #
37
Buil ing Owner Name Address
re-/c. 4. 6 n�t,o ryi 60 2.. 1.5 W 54
City era VG( State WA Zip 9c"'O o� Phone
Nature of Work A/ ,��p,,�
A_aPLIC!ANT
32 - 7/2
Name (F,M,L)
Address
>a ®•Box ago
City m i State W A Zip ?XO
Contact Person, Day Phone Other Phone Fax
ILOING CONTRACTOR
Company Name
Owner
Address
City
State Zip
Contact Person I Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
LEGAL DESCRIPTION /
Please Complete Reverse Side
CD0492 IRev 4/93!
I
Water Availability 9 Sewer Availability A On -Site Septic System Availability ❑ Project Valuation $
Zoning 7. Z r Lot Size _Z S 2 r j U Existing Bldg Valuation $
!J n c Cass -sS�n)
LENDER
Name Address
Contractor Name
�n v-
STRUCTURE
Existing Use
State
Proposed Use
Contact
Phone
Permit includes:
Building
(2( Plumbing
Wr Mechanical
❑ Other
lam°
Type of Work: 0 Residential
❑ New
❑ Remodel
❑ Number of Units
❑ Deck
Drinking Fountains
❑ Commercial
yB Addition
❑ Garage
❑ Shed
❑ Other
Lavatories
Enter 1 st Floor sq ft
' i�L 2nd Floor
sq ft 3rd Floor sq ft
Existing Floor Area
sq ft
Gas Dryer
Area Basement sq ft
Decks
sq ft Garage sq ft
Proposed Total Area
sq ft
Water Availability 9 Sewer Availability A On -Site Septic System Availability ❑ Project Valuation $
Zoning 7. Z r Lot Size _Z S 2 r j U Existing Bldg Valuation $
!J n c Cass -sS�n)
LENDER
Name Address
Contractor Name
�n v-
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
UMBING FIXTURE C¢TINT
Water Closets
Sinks
Urinals
Lawn Sprinklers
Bathtubs a,
Dish Washers
Drinking Fountains
Other
Showers
Electric Water Heaters
Sumps
Lavatories
Washing Machine
Drains
Total:
CHANTCAL UNIT COUNT
Fuel Type (electric /other)
Gas Dryer
Air Handling < = 10,000 CFM
15 -30 Tons
Length of Gas Piping
Range
Air Handling > = 10,000 CFM
30 -50 Tons
Furn <100K BTUs !
Gas Log
Unit Heater
50+ Tons
Furn > 100 BTUs A01C
Fans
Miscellaneous
Fuel Tanks
Gas Hwt t/
Hood
Boilers
Above Ground
Conv Burner
Duct Work f
0 -3 Tons
Underground
BBQ's
Wood Stoves
3 -15 Tons
T4 at i`in,t e'i i,
DISCLAIMER: I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge and further that I am authorized by the owner
of the above premises to perform the work for which permit application is made. I further agree to save harmless the City of Federal Way as to any claim (including costs, expenses,
and attorneys' fees incurred in investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way,
but only where such claim arises out pf 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. .11 f� //
Owner /Agent: Date: S % ! S
i