20-102931 ABDULLE GARAGE APPLICATIONCITY OF 1A
Federal Way
PERMIT NumBER _
SITE ADDRESS
PROJECT VALUATrON
$ 4s:
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is $5,000 or more
IRCW I9.27.095]
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-5325
253-835-2507 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
TARGET DATE
SUITLIUNIT #
ZONING ASSESSOR'S TAX/PARCEL #
BUILDINGS ❑ PLUMBING
❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
26OV-2a- 4-c
C
064,
NAME
PRIMARY PHONE
MAILING ADDItE$S
E-MAIL
CITY
STATE ZIP
LNA 9p23
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NAME
PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE H
EXPIRATION DATE
UBI 8
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NAME
PRDoISRV PHONE
Q ZJ�0
MAILING ADDRESS
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E-KAIL
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CITY
STATE ZIP
FAX
NAME
At x �
PRIMARY PHONE
a
MAILING ADDRESS
E-MAIL
Beth
CITY
STATE I ZIP
FAX
NAME
OWNER -FINANCED
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 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.
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 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 a part of this application.
SIGNATURE:
PRINT NAME:
DATE 7-7 4-�
A ��Nfl t3�c�r N
Bulletin #100 - February 19, 2020 Page 1 of 2 k:lHandout0ermit Application