20-101984-Building Permit ApplicationPERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER (33325 8th Avenue South ( Federal Way, OVA 98003-6325
253-835-2607 ( FAX 253-835-2609 ( permitcenter(a eityoffederalway.com
TARGET DATE ' -1 ' )16',
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TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DFNIOLITioN ❑ ENGINEFRING ❑ FIRE PRFVENTn)N
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of vvork to
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be included on this permit only
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PROPERTY OWNER
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CONTRACTOR
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APPLICANT
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PROJECT CONTACT
(The individual to receive and respond to
all correspondence concerning this
application)
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PROJECT FINANCING
fl'hcrtralneis S5,(f(Ntarmom
tRCW 19.111195)
[�' OWNER-
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I certify under penalty oj'perjury that I am the property owner or authorized agent of the property owner. I certify that to the best oj'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 o 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 pers tnc'Iudin$ the 4...ed, and filed against the city, but only where such claim arises out of the reliance of the city, including its
officers and employees, upon acc acy of the jnformadoh slOpv;ied to the city as apart of this application.
SIGNATURE:
PRINT NAME:
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Bulletin #100 —February 19, 2020 Page 1 of 2 k:\Handouts\Perinit Application