17-104062 AL
PERMIT APPLI._ TION
MYOf �� ���KNU
Federal +
Way PERMIT CENTER 33325 8th Avenue South+ 3-6325
253-835-2607+FAX 253-835-2609+permitcenter(atcitvoffederalway.com
AUG 22 2017
44 0 �
CiTY OF FEDERAL WAY
PERMIT NUMBER ' -7.-- n_ �/ _ � TARGET DATE MMUNI DEVELOPMENT
SITE ADDRESS SUITE/UNIT#
33820 Weyerhaeuser Way S, Federal Way, WA, 98001 Suite 100
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 19, 480 . 30 OP-1 2 1 5 4 6 6 _ 0 0 4 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ENGINEERING I� FIRE PREVENTION
NAME OF PROJECT NW Kidney Center Federal Way /`
Add and relocate required sprinklers for new ceiling
PROJECT DESCRIPTION
Detailed description of work to and wall locations
be included on this permit only
NAME PRIMARY PHONE
DM VENTURES-FEDERAL WAY LLC
PROPERTY OWNER MAILING ADDRESS E-MAIL
10900 NE 4TH STREET STE 1430
CITY STATE ZIP
BELLEVUE Wa 98004
NAME PHONE
Archer Construction 253-872-7222
MAILING ADDRESS E-MAIL
7855 SO 206th St permits@archerconstruction.com
CONTRACTOR
CITY STATE ZIP FAX
Kent Wa 98032 253-872-7277
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CC ARCHEI*219DR 04 01 /2019 20-00-101463-00-BL
NAME PRIMARY PHONE
Archer Construction 253-872-7222
APPLICANT MAILING ADDRESS E-MAIL
7855 SO 206th S t permits@archerconstruction.com
CITY STATE ZIP FAX
Kent Wa 98032 253-872-7277
NAME PRIMARY PHONE
PROJECT CONTACT Kenneth Kolbe 259-872-7222 ext 225
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 7855 SO 206th S t permits@archerconstruction.com
concerning this application) CITY STATE ZIP FAX
Kent Wa 98032 253-872-7277
NAME
PROJECT FINANCING 0 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 part of this application.
SIGNATURE: !t l�v1t\I \C(J\ <( DATE 08/22/2017
PRINT NAME: Kenneth Kolbe
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application