18-101849 RECEIVED
MAY 0 1 2018 PERMIT APPLICATION
CITY OF -f---,„,a.,,,.`
Fed ra IWayCITY OF FEDERAL WAY PERMIT CENTER t 33325 8•h Avenue South + Federal Wav,WA 98003-6325
COMMUNITY DEVELOPMENT 253-835-2607 + FAX 253-835-2609 + perrnncenterii itvoffederaIwav corn
PERMIT NUMBER k ( _ ( 0 1 _ �� 0ioils(
TARGET DATE
SITE ADDRESS ( SUITE/UNIT
-70( Oki �vctt way i `!
i
PROJECT VALUATION ZONING 1 ASSESSOR'S TAX/PARCEL i
TYPE OF PERMIT 'tuY,NG ❑ PLUMBING 0 MECHANICAL 0 DEYtOLITION 0 ENGINEERING 0 F:RE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION //c-� '
Detailed description of work to %J�� S,r�-it,,(t•l . ei.,1 leIV-6 f1 a<le LA../
be included on this permit only i f�
t
PRIMARY PHONE
N ) 4 (�I1lc
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAMEPHONE
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,it I r 1:-. 4.-0...&9,,,I,-1p- '5„,d [tem_ s.itte s \,'10 'cog oz V C)
MAILING ADDRESS• pQ c-- E-M y /
CONTRACTOR
�+1 2.7 —{ f` r' ✓1 it (, +J L')� 7 c.' A 1 4 t'1'• �y`,ra -'t1..4 +�
Ty STATE ZIP FAX �Gf;l
STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 4 NT
NAME PRIMARY PHONE
S'I v as( ( 4- -it t fie,--
APPLICANT MAILING ADDRESS E-MAIL
i
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT ,A'K./ CAS C ti nt fC''r-
Ilse individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence i
concerning this application) CITY ' STATE ZIP FAX
NAME
PROJECT FINANCING ID OWNER-FINANCED
WEen value rs$5.000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RC w•:4_7005)
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 inve ••• • • - • ense of such claim),which may be made by any person, including the undersigned,and filed against the city,
but only here such c a ' •rise •• • the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the cit as a paw of this application.
SIGNATURE: DATE �i!' ��
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PRINT NAME: ailiallir
, v!`!” Vie'•1 1 _
Bulletin P IOU-January 29.2016 Page 1 of 2 k '.I landouts\Permit Application