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16-101439illir AL REMED MAR 216 A. IMP 2U `� PERMITeiPPLICATION CITY OF ' - Federal WAYWay PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 C OF FEDERAL 253-835-2607+FAX 253-835-2609+permitcenterAcitvoffederalway.com // CDS PERMIT NUMBER 6 _ C j / 3 / _ �� / TARGET DATE lk__(0,,_, SITE ADDRESS SUITE/UNIT# z gyoy "ieirc ihq soe"7J PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL# $ f�Z 30 q/ & 'a0 - Dc) / sono. TYPE OF PERMIT ❑BUILDING ❑PLUMBING ❑MECHANICAL D DEMOLITION 0 ENGINEERING )(FIRE PREVENTION NAME OF PROJECT re�e�/AZ &// // eIre,e�� GA,��� / PROJECT DESCRIPTION "� I '/i 7 , Detailed description of work to be included on this permit only NAME ,y 1/642/0," / PRIMARY PHONE PROPERTY OWNER ,"s �r�v�x/9G ehty `6 2 h MAILING ADDRESS 5 33( "-55 STATE ZIP N3 4t / ►/ 1.i1i'r:it 51 PHONE s D -' '77.-�-�Z Z t� MAnnr . Q E-MAIL v) NTRACTOR — , 7 xI, g3itC.111. 1�t 4� T �/ The r C �� . FAX 57Z- S7/Z 0 W/I�,STATE CONTRACTOR'S LICENSE# ^ EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# - NPRIMARY PHONE ''' %',v $ u'&#y r-74/#/- 7L 99 APPLICANT ' ',G ADDRESS E-MAIL /:7 13e,/--4,e,/j g- /1e-� Toy ecuv e,,,x�b.�,S#ri re,Fy ca ,o> �`/ l�.v, �7lo/' FAXAin- NAME PROJECT CONTACT 7 o�' (0, De i,1 PRIMARY e77-974'f (The individual to receive and MAIIANG ADDRESS E-MAIL respond to all correspondence /g7 Z y /moo // c 0//e.7. Teo"e0577LG IQ 012/59C10/I15'0y Co concerning this application) o/ag// STATE �Dti FAX PROJECT FINANCING NAME 0 OWNER-FINANCED When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.27.095) 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 authorised 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 t -11r, as a part of !, ..lication. SIGNATURE: ' DATE //7 /L PRINT N , 07 ee S 777/G.t3 Bulletin 11100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application