16-106134PERMIT NUMBER ` � _
PERMI*APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcent�v�c;it_Vof edderahvay.cam
H-, IS 7;16
TARGET DATE
SITE ADDRESS
2315 SW 320th 1
PROJECT VALUATION
ZONING
ASSESSOR'S TAB/PARCEL #
$ 3000
1 3 2 1 0 3_ 9 0 33
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
Dr. Egger
PROJECT DESCRIPTION
Detailed description of work to
install ne itrous oxide and.A oxygen for dental office
be included on this permit only
NAME PRIMARY PHONE
Humaas Farms LLC William Karges Jr.
PROPERTY OWNER
A (AILING ADDRESS
E-MAIL
PO Box D1
CITY STATE ZIP
Carmel CA 93921
NAME
PHONE
Head Mechanical, Inc.
MAILING ADDRESS
E-MAIL
600 Storie Ln.
CONTRACTOR
CITY
STATE
ZD'
FAX
Cie Elum
WA
98922
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
HEADMM191203 0R 15 / 2017
NAME
PRIMARY PHONE
Terri Head
509-674-6972
MAILING ADDRESS
600 Storie Ln.
E -MAH.
terri@headmechanical.com
APPLICANT
CITY
STATE
ZIP
FAX
Cie Elum
WA
98922
NAME
PRIMARY PHONE
PROJECT CONTACT
Jeff Head
206-730-5178
MAILING ADDRESS
600 Storie Ln.
E-MAIL
'eff headmechanical.com
(Pte individual to receive and
respond to all correspondence
CITY STATE ZIP
FAX
concerning this application)
Cle Elum WA 98922
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.(
I certy%p under penalty of perjury that I am the property owner or authorised 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.
1 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 cluing, which may be made by any person, including the undersigned, and flied 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 apart of this application.
7�G daa'l DATE 12/23/16
SIGNATURE: Y i
PRINT NAME: Terri Head
Bulletin # 100 — January 29, 2016 Page i of 2 k:\Handouts\Permit Application