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16-102930
‘. • PERMI'1OAPPLICATION MY OF Federa Way PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325 253-835-2607+FAX 253-835-2609+permitcente�pcECEIj 1tE® PERMIT NUMBER /( - / 0 z ,�,' 2.-Cp MAY 15 201 - - TARGET DATE CITY OF FEDERAL WAY SITE ADDRESS SUITE/UNIT PDS c 6714 AvE S PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 2400.0 0 op 9 6 s o o - 0 3 N 0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERINGI'+IRE PREVENTION NAME OF PROJECT kuWz'r PROJECT DESCRIPTION itvD1db/Q6[nGretsac hvd5v/VsS�kL 0/:vs(c) as) TI t XsstSvi. FSI�E AUltM SySIKA,, Detailed description of work to AbOlA+b!Rt;LotAIIJJ t SNSTsAtsI. ai'lct DAr '[N6 64150/ nitt halo" Sy3IE/ , be included on this permit only NAME PRIMARY PHONE Ea3F3t.F IA/Vf57'o1-S LLC. PROPERTY OWNER MAILING ADDRESS E-MAIL 319ST OOhAvE s CITY STATE ZIP Eb041.. Why Wh C1800) NAME PHONE W STERAJ STA1ES Fin c' 9'JX.1JQAi HIS-1110-0 too MAILING ADDRESS E-MAIL CONTRACTOR HO N4'4)1E 415Th ST 01 50'h,tENlvDtrkeW ovS CITY STATE ZIP FAX RtbIh©A)Q WA 9$oa a. L a5-$'4s1-30NO WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# WES1E5F906PI 11 /0q / t6 19-`19-1o6y16•-(90-Bi- NAME PRIMARY PHONE .Sf.m Z.i;)NDEIL APPLICANT MAILING ADDRESS E-MAIL 1LI690 A) `i57HSi 4k-Io1 5L1H.trhNate.�wsFP•vs CITY STATE ZIP FAX ttbANOivil Wk 475 30o NAME PRIMARY PHONE PROJECT CONTACT 5E114 IEHNAElL 11).5-1416_g3oq (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence MAO NE (45T% ST -Io I SEfM. EHJviJERgilwSFp,o46 concerning this application) CITY STATE ZIP FAX REAADAill \V Cf a5)- 105 sal-3 of o NAME PROJECT FINANCING ❑ 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 the city as a part of this application. SIGNATURE: A I DATE 615/16 PRINT NAME: ,4.�F'T Vi q.F 14 A11371_ Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application