12-101758 .
• S3uilding - Commercial
CitFy Way Permit #: 12-101758-00-CO
Community
&Econ.on.Dev.Services
33325 8th Ave S
Federal way wA 98003 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: UW PHYSICIANS NETWORK
Project Address: 32018 23RD AVE S Parcel Number: 162104 9028
Project Description: REP-Inspection vehicle damage. **NO construction work approved under this permit**
Owner Applicant Contractor Lender
FW TOWNE SQUARE LLC ONEDURR INC
P 0 BOX 98922 10310 S TACOMA WAY SUITE K
TACOMA WA 98498 LAKEWOOD WA 98499
Census Category: 999 - Unknown
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
Additional Permit Information
Mechanical to be Included? No Number of Stories 1
Permit for Building Shell Only9 No Plumbing to be Included9 No
New/Additional Sq.Feet-Total 0
No Fixtures Associated With This Permit !!
PERMIT EXPIRES Wednesday, October 17, 2012
Permit Issued on Friday, April 20, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
�, and the City of Federal Way. �i
Owner or agent: *i/f„c ,zi /CG `1 Date: ' 2o '_r�-
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Feder- a r�'� PERMIT SF MF CO ME PL DE EN FP
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COMMUNITY DEVELOPMENT SERI 9' APPLICATION
253-835-2607•FAX 253-835-2609
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SITE ADDRESS' SUITE/UNIT#
3 2.0\i5 2'b`-- (�‘..e... S S. '' e „-e.-\ IN) t V) A
$ PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
- ' o y _ 9 0 Z. 911
TYPE OF PERMIT 'BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ NGINEERING ❑ FIRE PREVENTION ej'4ik.
NAME OF PROJECT u J
(Tenant Name/Homeowner Last Name) /1 j
-,"1?
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER \L, 'Cr1 C.., .1.-\y,cktLS Q m t,R\t- S 111-k-- $ 4 O t
MAIIJ'
``JJ lGG ADDRESS E-MAIL
66 `f3 6K `ao1 'LZ
CI Y `` STATE ZIPP p qq
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NAME PHONE
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O c\.s!e' , •.y-c„f . Z$ $�1'� - Z\b S
MAILING ADDRESS E-MAIL
CONTRACTOR \()b‘.0 Sp AN\1 ..V.c.. K
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CITY STATE ZIP FAX J
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME IN
PHONE
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APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and (._..\" ' (6�0-c— LS 3 lock l. -- \3t)
respond to all correspondence MAILING ADDRESS \\\ E-MAIL
concerning this application) kb 3(,I Co.\r\ c.cv;�� �a_y �t\en�®011e e�.Nr�.a'nXtnC.tom
CITY STATE ZIP J FAX J
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ALTERNATE CONTACT NAME: PHONE E-MAIL
w.e_ It. /w2-SS-31-1-`\s ..} ot,eevv-eto„-rJr meq.corn
PROJECT FINANCING NAME
IQr /t ^ J
N / /� ElOWNER-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 regulationspertaining 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 such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where such claim es out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the 't as a part of this application.
SIGNATURE: DATE LA-- ke ^\S-
PRINT NAME: \>O* — ��Yv--
Bulletin#100-January 1,2011 Page 1 of 3 k:AI-Iandouts\Permit Application