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18-105761
CITY OF Federal Way RECEIVED DEC 0 7 2018 CITY OF FEDERAL WAY COMMUNITY DEVELOPMENT PERMIT APPLICATION ftmm CENTEa + 33325 8th Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + perinitcenter0cinroffederalway.com PERn= NUMBER i _+ o s 7 (42 I_ P N — TARGET DATA SITZ ADDRZM 0 164 SW Campus Drive, Federal Way, WA 98023 7/U. PROJECT VALUATIOX ZONING A88Z88OfM TAX/PARCZL e t 40,000.00 A-9— 4 1 5 2 --Q- TYPE OF PERMIT TWE ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION NAME OF PROJECT Pack Dental Services PROJECT DESCRIPTIOIii doubleSetting the a-4"—fire line to the buildina Detailed description of tuork to be included on this permit only NAME PRUTARY PRONZ Covenant Real Estate Group 714.845.8500 PROPERTT OWNIM IIAD.IIIG ADDR288 Z-IfAb 17000 Red Hill Avenue aguoncApacden.com CITY STATS ZIP Irvine CA 9261 NAM PMUZ Ala206.607.4942 WMAR. v V ` R I -Red 11 rickeyc@alanbrookeeonstruction.corr CITY81A ZIP Belle A 98005 PAX 11I1� !!'RACTOR'8 LICE:B ZXPMTIORDATZWA CL840P 09 30 19 P2Z0Z-R1AL8W-A1Y0E4D49Z86-L00Z-Be RAM Rick Crane PBDIIARY PRORZ 206.355.3979 APPLICANT rtAZEMM ADDRZ86 12505 Bel -Red Road Ste 110 9-m, fteyc@alanbrooke=stiuction.corr COY STATZZiP PAX Bellevue WA 9 00 ewid PROIARY PRONZ PROJECT CONTACT Ronald 5hearer206.607.4942 rMe individual t0 receive and 4AlL= ADDRI= Z-KAa respond to all correspondence rasheamr6l@gmail.com CITY BellevUe "ATZ WA ZIP 98005 PAX concerning this application) PROJECT FINANCING RARR © OWNER -FINANCED When vahue is $5,000 or more MAD.IRG ADDRZW CITY, STAM ZIP RON (RCW J 9.2 7.095) I eart(fy under penalty grperfury that I am the property owner or authorised agent of the property owner. I cert ft that to the best of my knowledge, the in formation submitted in support of this permit application is true and correct. I eert(fy that I will comply with all applicable City of federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that chs issuance gf this permit does not ramose the owner's responsibility Jbr compliance with local, state, or federal laws regulating construction or environmental laws. I Jlurther 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 clataij which may be made by any person, including the undersigned, and jlkd against the city, but only where such claim arises out qr the reliance of the city, including its gjoUers and employees, upon the accuracy of the iriformation supplied to the city as a part of this application. i SIGNATURE:� DATE f��•-7�`==1-'�d PRnrr NAM: Rick Crane Bulletin # 100 - January 29, 2016 Page 1 of 2 k:\HandoutslPermit Application