22-102571RECEIVED
,Lev n . � JUN 0 3 2022 �
C"T V yOggF lgz PERMIT APPLICATION
O ff'
Fe ,.$era kf �,� -, v CITY OF FEDERAL WPR�T CENTER �' 33325 81hAvenue South + Federal Way, WA 98003-6327
r 53••835-2607 + FAX 253-835-2609 + eesD�tcelli
CpMMUNIT(flEylrLdPMF.l el�itnih oifedelaktay.cor
PERMIT NUMBER
- THRQrliT DATE
SITE ADLD"SS
¢`� �q 5�°�' gp l¢��-,r�.3 g f ,�q g� 'gam{ {��{ ���yyy SUIT)',/UNIT #
X.
1 PR UEC'r LUATXOX 2QIMffI G HSSESSOWSTAX/PARCEL #
- 9
T"E OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ RREPREvrm-rION
NAME OFPROJECT Sur-Lrise Wdvnre R1r d-rA'Gi CGre LLC
PROJECT DESCPIPTION
metalled description of nark to
be included on thispermit only
PROPERTY OWNED
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The indiuiduai to recetue and
respond to all correspondence
concerning this apptico.tion)
PROJECT FINANCING
When ualue is $5,000ormore
(RCW 19,27.095)
L11A 1 c na1• Name I
'Rob >c4 karioka
WAILING ADDRESS p�
Sa2Q. 24 ���1 P1 9W
CITY
MAILING ADDRESS
CITY
WA STATE CONTRACTOR'S LICENSE #
MAILING ADDREW
' C94
crry
r-ect4rIni
R ob M,. ;At-; L* %
MAILING ADDRESS
300124 5(444) PI QA/
CITY
MAILING ADDRESS, CITY, STATE.
STATE I ZIP
WA I WAS
STATE ZIP
EXPIRt1TION DATE
IT,T.IP p� egg vg
WA
STATE I zD
%4/A qua.
E-MAIL
FAX
UBI #
PMKARY PEON$
'104-��9�
E-MAIL
FAX
!'BINARY PAONF,
E-MAIL
FAX
❑ OWNER -FINANCED
X certify under penalty of perjury that I am the property owner or authorised agent of tote property owns)'. 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 jr 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,
Taut 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 tR ! city as apart of this application,
SIGNATURE: — _ I -a�yp
P1RIi+iT jkTAlt'M, R06,&-Y
r- Vki
71202,1
Bulletin #100 -February 19, 2020 Page I of k:\Handouts\Permit Application