17-103614 CITY OF A PERMIT APPhig nON
Federal Way
JUL 272017
PERMIT NUMBER 3c0_ I _ t TARGET DATE CIM OF FEDERAL WAY
-
— — COQ UNITY DEVELOPMENT
SITE ADDRESS SUITE/UNIT it
3 3 gj0 WeyerIio e.user 'Way S /rt Poop-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL
$ 2,700 2 l S L1 6 6 - 0 0 3 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL ❑DEMOLITION ❑ ENGINEERING ® FIRE PREVENTION
NAME OF PROJECT filackc Qy + Sloos?�`-ec Tr
/11,7,1;6
PROJECT DESCRIPTION �Jex429 r/Ori h k ler- syc S to ws dor new r-eh.an
Detailed description of work to try rOV6Wl ein f. WOL(Is,
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER /11 D Ventcares TAlovi LLC
MAILING ADDRESS E-MAIL
33 g1 weer-haeuser W S
CITY STATE ZIP
Fe demi Way w.4 R8v01
NAME Patriot Fire Protection, Inc. 253-926-2290
MAILING ADDRESS 2707 70th Ave E E-MAIL
CONTRACTOR dCWAI•christen soil@perfrkrtf r'e.o
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
WA STATE CONTRACTOR'S LICENSE 41 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
PATRIFP099CF 10 / 05 / 16 19-91-101988-00-BL
NAMEf-1 � PRIMARY PHONE
C,gvii'1 (.//���Ir�Sy$✓I,sOY1 2S'3-qz6-zzgo
APPLICANT MAILING ADDRESS EMAIL
Same as above flavin.CA 5T en son€parrrDrfcre.cam
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence Same as above
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING D OWNER-FINANCED
Required value of$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. 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 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 supplied to the city as a part of this application.
SIGNATURE: As..40/r DATE 7/2A/17
PRINT NAME: D viP1 ( rI S7-P iJOvl
Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application