11-101794 ,� ; - t 71
Federal 5 PERMIT SF MF CO ME PL DE EN
° "'"lf'Nli''DEVELOPMENT
SE' ,,,�+. 11t1APPLICATION
253.835-2607•FAX 253-835-2.`x•
DeRik
CIS°
SITE ADDRESS SUITE/UNIT#
1207 South 320th Street, Federal Way,WA 98002
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 109,000 CC-F 1 5 0 0 5 0 0. 0 2 0
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING KI FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Safeway Fuel Convenience Store
Install two new 20,000 underground fuel tanks.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MGP IX Sunset Square, LLC,do Merlone Geier Management 858-350-1977
MAILING Carmel Mountain Road#260 dg ie ser@merlonegeier.com
zus
San Diego STATE 92130
1
NAME To Be Determined PHONE
MAILING ADDRESS E-MAIL
CO
,\rt. CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE it EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE it
NAME PHONE
Bob Blair-Safeway Inc. 425-201-6401
APPLICANT
SPO BG ox 85001 Bob.Blair@safeway.com
CITY Bellevue STATE FAX
ZIP F98005 425-637-2267
PROJECT CONTACT NAME John Llacuna-Stantec Architecture 425-298-1066
(The individual to receive and
respond to all correspondence M' 20 3434 134th Court NE, Suite 102 john.11acuna@stantec.com
concerning this application)
CITY
Redmond z" 98052 FAX 425-198-1019
ALTERNATE CONTACT NAME: PHONE E-MAIL
Duncan Wallace 425-298-1063 duncan.wallace@stantec.com
PROJECT FINANCING NAME
ECI OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY.STATE.ZIP PHONE
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 c •• •, which may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises o of t • reliance of the city, including its officers and employees, upon the accuracy of the
information suppl to the, a ' of *application.
SIGNATURE: DATE ._ ` i) (
PRINT NAME: ' I ~V\ L-71(\C (1 \
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application