21-105251-��
cirr of
Federal Allay
RECEIVED
PERMIT APPLICATION
DEC 13 2021 PERIL T CENTER + 33325 S' Avenue Sautn t federal Way, WA 98003 6325
CITY OF 253-835-2607 t FAX 253-835-2609 + permitaenterCOcityoffederaIway.com
PERK= NUMBER
�HiTY � ER'4L WAY� � �LOpME W
SITE ADDRESS ~
PR011rCT VALUATION
$ IofTA9
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
STATE ZIP
6ri boa►• -fir
CITY k�
1
wA aTATZ CONTR,ICTQR,S LICENSE N
��- M5Tc,,1.Z* ,Ol
�ArLnvo Annrtess
NAIM
PROJECT CONTACT
(The individual to receive and MAII.0oAbDXN8
respond to all correspondence r
TARG$T DATE
r �y
AS9ES.SQZONING R'8 TA?L1PA1tC$L 1
5't1iTElUNIT
BUILDING ❑PLUMBING ❑ MECFIANICAL C+ DEMOLITION I] ENGINEERING ❑ FIRE PREVENTION
c 1
Ae�
MAII,1A(: ADbRB
cry
rr+��
NAMF,
MA XNG An=0 i111
7TAL* ZIP
E7Q'IFATIOF DATE
. s.
PRIMARY P80NE
&►TAIL
rxorra
8-MAIL
FAX
U8I M �r
P�AAP FHQli£
FAX
Fila AR PHONE
i ` "M r
F—hL
concerrang this application) CITY 'j 4
aTATe
PAX
PROJECT FINANCING NAME
yy, �y ��
When. value is $5,000 or more , r 1 r k , rL �+1�
(fi4'W ! J.2 T. 996J
MArr�o Abni'Eae. CTTY, s7ATE, 2Ip l Ljfn [�' y^ ❑ OWNER -FINANCED
Col.
Rcc�:�n, Prlozirr
I certtfy under penalty of perjury that I am the ojmy knowledge, the too F�perty owner ar authorized agent of the roe r all applicable Ci r rmatWa submitted In support of this pernsit application is true andP-Pesty7 wner. I certgy that to the best
ty aJ FecrEral Way regulations pertaining to the work authorized certTy that I u,Ill co I
issuance of this permit does not remove tite ow
res rnp y with
canstructiar: or envtrenmentaI laws. I�nstbili y the
issuaiece °j a PQ77lett I understand that the
for camirliance with local, stxyt<, or federal Laws reyuloting
I further agree to hold harmtass the City of Federal Way as to any clahn (tncludi,sbe made by any parson, I'let y �is� �penyes, and atCarneys' fees Incurred in
the investigation and defense of such oral
but only where such chain arises out ofye releance" which y f he city, inclurlingts o siding the underst ne
Information supplied to the city 9 d, and filed against the city,
/ as A art pjthis application. ,ffIcers and employees, upon the accuracy of the
STA
kj j ZIP
SIGNATURE; 1
PRINT NAME: may, DATE-
Bulletin #100 —February 19, 2020
Page 1 of 2
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C�Y�
k lHandoutslPerrnit Applicadon