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20-103602 -Building Permit Application-09-23-2020-V1
PERMIT' APPLICATION CITY Of4% PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325 Federal Way 253-835-2607 + FAX 253-835-2609 + permitcentertacityoffederalway.com PERMIT NUMBER _ _ ._. TARQET DATE SITE ADDRESS S+ Fed eNl May M/A WOO SUITE/UNIT # 716 S 348 , PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # 0 $ 75, 000 3 3 1 4 5_ 0 0 0 TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT Ukrainian Federal CerCA"t V"'On 16 &�V(Jylqc -to eyisfiljb yt or D PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAME PRIMARY PHONE V t- Iit yt FeAe—1 Creech tJrii0i1 (253) 237-914q PROPERTY OWNER NAMING ADDRESS 14 S sf Rid c �Roacl EMAIL aerc �1ECt iniUU t cci.�►r9 CITY oc�ic�'f�r STATE 6V Y ZIP 1 . i NAME TAD MAILING ADDRESS EMAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE UBI # NAME PRIM.AR�YtPHONE A`I',g, e x Kt~ bas02Z3_-7i4"63 MAILING ADDRESS 215 le Qlyol. E-MAIL rAk1,v qQSfud,'abo APPLICANT CITY Sectole STATE I wh ZIP qll.? # FAX NAME PRIMARY PHONE PROJECT CONTACT Same OU Q l;ca MAILING ADDRESS EMAIL (The individual to receive and respond to all correspondence concerning this application) CITY STATE ZIP FAX PROJECT FINANCING NAME C4 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 authorised agent of the property owner. I certify that to the best knowledge, the irformation submitted in support of this permit application is true and correct. I certify that I will comply with Of my all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the I the responsibility for compliance with local, state, or federal laws regulating issuance of this permit does not remove owner's 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 which may be made by any person, including the undersigned, and filed against the city, the investigation and defense of such claim), 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. ©e/. L 1-` 2OZO EW SIGNATURE: 1 DATE fa t x, e — PRINT NAME: _ Bulletin #100 -February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application