20-101804-Building Permit Application-05-06-2020-V1qqqk
CITY OF
Federal Way
PERMIT APPLICATION
PERMIT CENTER 33325 811, Avenue South + Federal Wav, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(cicityoffederalway.corn
PERMIT NUMBER
TARGET DATE
30625 11TH AVE. SOUTH FEDERAL WAY
W
j SUITE/UNIT #
SITE ADDRESS
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$800
-
TYPE OF PERMIT
BUILDING
NAME OF PROJECT
OUTSIDE RAMP
PROJECT DESCRIPTION
Detailed description of work to
ADULT FAMILY HOME ACCESS RAMP
be included on this permit only
NAm,jJACINTA KINUTHIA CHARLES NYONYO
PRIMARY PHONE 2533340896
PROPERTY OWNER
30625 11TH AVE. SOUTH
E-MAIL
MAILING ADDRESS 3
KINJAC2005-a YAHOO,COM
CITY FEDERAL WAY
STAT
ZIP 98003
WA
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI P
NAME JACINTA KINUTHIA
PHONE 2533340896
11th ave. south
E-MAIL
APPLICANT
MAILING ADDRESS30625
CITY FEDERAL WAY
STATE ZIP
FAX 2064298424
WA 9S003
NAME JACINTA KINUTHIA
PRIMARY PHONE 2533340896
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
30625 11TH AVE. SOUTH
respond to all correspondence
CITY STATE ZIP 98003
FAX 2064298424
concerning this application)
FEDERAL WAY WA
i
PROJECT FINANCING
NAME
❑ 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. 1 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 supplie o the city as a part of this application. +,\K- - C�� - 2C)20
SIGNATURE: C7�' DATE
PRINT NAME: ��_ c—