17-100430 01/2712017 16:56 3606588207 WHITE SECURITY SYS PAGE 01102
• oczveD •
1
AN g 0 7.'11 PERMIT APPLICATION
CITY CO
Federal Way �. t:tA11 ,` bill CENTER+33325 8m Avenue South+Federal Way,WA 98003-6325
r `Gi 6 0°,4 253-8352607+FAX 253-835-2609+permitcenteraCitvoffederalway.com
PEaritT NUMBER 1 1 _ 1 00 U 3 0 - F p TAS GET DATE 1 - 3O-2 D 1�
SITE ADDRESS SUITEIUNIT I!
3 !-7D5 ?Otot,-( -1-c, 1•14,0 4,2A)L0-ii)
PRWBCT VALUATION ZONING AS R'S ' FA Bt.# 4
$ %00 1 0 - ` j . `� �
TYPE OF PERMIT p BUILDING C] Pi,utsatINo ❑MECHANICAL D DEMOLITION 0 ENOINEERINO Jd'KRE PREVENTION
roaq i
lt
NAME OF PROJECT + �r� y
PROJECT DESCRIPTION TOM' g)0 UV ' a,) rid I
ii
Detailed description of work to
be included on this permit only
PROPERTY OWNER mi
�� �V I Q 1l I + Yrsr1i
a �o
ntAILINO ADDRESS EMAIL
CrrY STATE I ZIP
k n
N V/6
4 c CU lei S*IIS 25 2`V3Lo1'
CONTRACTOR 11 1, killV OM I Ce f n '1 Z -eat. ( ,�3
%,- a-267
ilirnr\kE MTV MIDI 21/3
V
NAME lila" q% (1101 PRIMARY PHONE
APPLICANT !ammo somata ' E-MAIL
CITY r STATE I ZIP FAX
N .t IJ T ti
PROJECT CONTACT y. /�,
(efte individual to receive and ff� m e V V h tleSl 1�t l� '"'—
respond to all correspondence il
concerning this application) ---11 _—– l Im .41 t 68--U If ul
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more
(ILCW 19.27.095)
I certify under penalty of,perfury that T am the property owner or authorized agent of the property owner.I certify that to the beat
of my knowledge,the information submitted in support of this permit appiica-tion is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that the
issuance of tide permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental Iaws.
I further agree to hold harmless the City of Federal way as to any claim(including costs,eepenses,and attorneys'fees incurred in
the investigation and defense of such.°Taim),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, inciudiny its officers and employees, upon the accuracy of the
information supplied to the city as a p of this application.
i4IGAiATTF DATE1 l' 71
J (7
PRINT NAME: 1J1' r^Y Vt V e l
Bulletin#100–January 29,2016 Page 1 of 2 k:\Handouts\emit Application