20-102337-Building Permit Application-06-15-2020-V140k
CITY OF
Federal Way
PERMIT APPLICATION
PERMIT CENTER + 33325 8N Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter cityoffederalway.com
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NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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❑ OWNER -FINANCED
When value is $5,000 or more
ADD , vrAm ZIP
PHONIC
(RCW 19.27.095)
I eerttfs under penalty of perjury that I am the property oumer or authorised agent of the prop" owner. I cerft that to the best
of my knowledge, the to jormatton submitted in support of this permit application is true and correct. I cart(& that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the
Issuance of this permit does not remove the owner's responsibMy for compliance with local, state, or fideral Iaalu 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' Jew incurred In
the investigation and defense of such cl t 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 o(J[are and employees, upon the accuracy of the
Wormatlon supptied to the city as a part of this application.
BIGNATIIRE: - / DATE
PRINT NAME:
Bulletin # 100 - February 19, 2020 Page I of 2 k.\Handouts\Permit Application
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