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16-102912 Nh, III PERMII•APPLICATION CITY of ' Federal Way PERMIT CENTER+33325 8th Avenue South+F-•eral Way,WA 98003-6325 253-835-2607+FAX 253-835-2609 + .ermitcen,, k o i i i s n., m al i — / 0 Z / _ JUN 14 2016 PERMIT NUMBER / TARGET DATE CITY OF F�C(}DERgL WAY r / SITE ADDRESS3 ` SUITE/UNIT�iS Z 2 �r V E: `V 1NS PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ aoOr;O 2— 1 6 S- - a 0 �` o TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING .2 FIRE PREVENTION NAME OF PROJECT loF� wJ5Uitec`, PROJECT DESCRIPTION W ENA 13 Wet 57M-ill- T L Ref°c te- I �© 3pYl4 l er Detailed description of work to I-te s be included on this permit only NAME PRIMARY PHONE ---_. -S Tech IA ves-t or i_i-c, PROPERTY OWNER LING ADORES E-MAIL �Iz z i41) Av,e, s STATE ZIP TYge aet,'C<.1 1A41 wf g v 0 0 I NAME O �i& -hie -2-32--3561 MAILING ADDRESS E-MAIL] / f CONTRACTOR 'l1 S• Tr,nAlGj 5- '+if�ta(!LdCC'/Go'SI( '(E • 4 ,Ty SiTA E ZIP(� 5 ,-r1 V"►� 7x/08 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# Go F-z cis-2-14 GI_ _7 i31__/ /( , 0-0(1-1,20:f.17-00-13L NAME 1-4PRIMARY PHONE �, a04) 22q-75-2-4 APPLICANT MAILING ADDRESS E-MAIL // ,�r' ((1 S• r=indl4ly >r /isrl,' a0/-1 .t,- c,frieiy CITY STATE ZIP 56ef-( VIA q /0 5 N �� PRIMARY PHONE PROJECT CONTACT 6__ 1......1, 1 0,96)-22-q22-q7S 2 [c� (The individual to receive and MAILING ADDRESSi.ff E-MAILp respond to all correspondence U I I S` A G1 ky . T 1.jcLo 1 i CAC oive 6ittlYe.-Met concerning this application) CITY �/ STA E ZIP FA# 5-eAttlt kV P3/47& NAME PROJECT FINANCING 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 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 th city as a part of this application. ,�j SIGNATURE:. a. DATE ®6/ r K//V PRINT NAME: 1i.. &' Lk Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application