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17-102224 o c:, . 17-Es I SUS �lr 2 Am__ ► PERMIT APPLICATION CITY OF Federal Way PERMIT CENTER+33325 8th Avenue South+Federal Wa W 003-6325 253-835-2607 +FAX 253-835-2609+permi t .com ( � - 1 0 2 Z F-1> MAY 12 2017 PERMIT NUMBER _ _ TARGET DATE CITY OF FEDERAL WAY COMMUNmr nFVFt OPMEtif SITE ADDRESS SUITE/UNIT# I)6 ,S- Pis\e_4 =-K__ It.J4 S PROJECT VALUATION U� ZONING ASSESSOR'S TAX/PARCEL# , f /'-' $ ,,. (j. (t '1,- i _ 6 `- - 9 1 2, 0 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT 1 \C-C.J PAP04)kidV-1 i& A \ i lotk_ 4\ 1\--A/3 �i a' A M C A TYci 1 r PROJECT DESCRIPTION ( �^ Detailed description of work to t �I 1)-1 M ��,x O i` k ivc) -9P ►° L' - iU: C: be included on this permit only * ,1E--W ,INC! 02031 NAc 170 S� 1 )CO f i� ��- .--�� 4 PFUMARY PHONE �Z 40 b-a1''# PROPERTY OWNER MAI ING ADDRESS -r.i / E-MAIL 4 go l j(06 In �\I`�% IG J)- CS H2O,eck 9IMATtcz t&c,C;rw C ZAmto) STATE ZIP NAME, C .,^ (� f� 1 PHONE MAILING ADDRESS � . q yE--M,AIIL !�,_ CONTRACTOR �� S L QAL St 44 ''l H."'&-F1'E5' ' '`•" `ilx,Cur CITSU STATE ZIP/I t rs, FAX��I • rl (t' WAOITATrRACTORt bq f 02- LOI /i EXPIRATION 7 t -IC t4 LICENSE DATE FEDER*WAY BITINESS CO CORL. NAME _ I Y PRIMARY PHONE C tV 1 I -2,ot,, -�(27: i+CO APPLICANT MAILING ADDRESS E-MAIL / (o-© S L,OG 1,i Cr R�c' 1CSAt , t itic- CITY /� _ / S ZIP ^ FAX2C(c) 762--114M 76�'-' q -i--- i-k- 1�I��•C�� (S,f( - NAME •-�� PRIMARY PHONE, /.:. PROJECT CONTACT ► 5:"S 3I 4 LL.I�� '' LS HUS-2- L' `I, MAILING ADDRESS E-MAIL,,_,, v (The individual to receive and L)l 6 S �t f(� t I •-" S k i ;��`,,F fl 1 v�11tyw, .. respond to all correspondence �/v �-t.� .�/Cv� concerning this application) CITY . / STAT ZIP FAX, ,.,._d \ q �� 761-1.49 PROJECT FINANCING NAME 0 .S �P�co (SQ. ❑ OWNER-FINANCED When value is$5,000 or more I7,�}_GADDRE`SS,C��7,TY-,,SSTATE, IP_ Is,.. .,,,:: j� 'nl f' PHONE (RCW 19.27.095) `x+1 I11 IrT Y '� �k G 10 42.r' gal-S-617' 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 ci y as,a part of this application. f SIGNATURE: � J ' DATE PRINT NAME: cj� C1 �. lT`" '�--Lf Bulletin#1(X)-January 29,2016 Page 1 of 2 k:\Handouts\Pennit Application