20-101037 RECEIVED
_4441114",..„CITY OF
MAR 06 2020 PERMIT APPLICATION
Federal Way CITY OF FEDERAL WAY , PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
COMMUNITY DEVELOPMENT/ 253-835-2607 + FAX 253-835-2609 +permitcenter()cityoffederalway.com
PERMIT NUMBER /— J J / 13 3 7— T
��VJJ //// V / TARGET DATE \�
SITE ADDRESS SUITE/UNIT#
109 SW 292nd Street
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 10,500.00 1 1 9 6 0 0 0 9 8 6
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT J. Singh Residence
c�
PROJECT DESCRIPTION �SA-a'1G'�'I o� d� l'�*IL 5( c i vx S yc�4-tw l .
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
S�ogkA zoco-Ts-30-OGS
co
PROPERTY OWNER MAILING ADDRESS E-MAIL
23-1113 11Lk"' E JO--, ZS* coy
CITYSTATE ZIP
1�e _vv'-- WPC- 9So3o
NAME PHONE
c1/4w 4. c-60 ,2 1 -9,00
MAILING ADDRESS "' 1�\1. ` E-MAIL
CONTRACTOR ESO 1 a 1 LQ_� rtv Q. N VsJ Sly\ D \S�Gi N4 sACY?. Co N`i
CITU'1G 11 u p STATEI A ZIi1 (
FAX
WA STAT ONTRACTOR'S LICENSE# w EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
IA CM P30IC.P()R-2ICr/5/ 12/3t /2020Z0-fl-(03193-co-3L
NAME PRIMARY PHONE
SGYw2 QS COv\*rc c+o�'
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT 1 t-r i5 N\f i 01S 'z 5 r�O 3-o -9900
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence X01 11'e N W SU' -C, lJ titfVlsl\Pk.cl 114,0K FP (ah
concerning this application) C,ZY STATE ZIP FAX
`1 311
NAME
PROJECT FINANCING ❑ 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 Iaws 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 suppliedlo t a part oft -s application.
SIGNATURE: DATE 2.020
PRINT NAME:"VCIV J VIV I S i C a� J
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application