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17-105207
RECEIVED '` 7 ] y PERMIT APPLICATION CITY OF OCT L I 2al� O FederalWCC PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 CITY OF FEDERAL WAY 253-835-2607+FAX 253-835-2609+permitcenter(iicitvoffederalway.com COMMUNITY DEVELOPMENT �� PERMIT NUMBER / _ / 0 5 .,( 0 - F P TARGET DATE SITE ADDRESS t v, v SUITE/UNIT# 2"4 S ' 3 Zo'r-4 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 2.3 (s7 , OC) b 9 2.. 1 0 (4 - 9 2 `7 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECT AA o C f( Z ZA PROJECT DESCRIPTION U1/414-rA tit. A NS,(A.(. (•JET Cae..." Lc.AL- P t I�.E Detailed description of work to .SIA-Pee-e-",7 03 F•-1SL( S T t /. (tjT6 K_rj--ci- -,. be included on this permit only 140 9_ ©D © )c� F"`Z-z . OVG-c.;\.1NAME FSO C PRIMARY PHONE N we ,.. C€nrrEr2 PLAZA LLL PROPERTY OWNER MAILING ADDRESS E-MAIL 2_01`k S : 32u 5t • T"t STATE R. 'r a-% i . .1 vj 1.4. ZIP 0 O 3 NAME PHONE *'t c D A t b(,.c.:r- rev(c€S 2 d to '--r 2 , 'og Lid MAILING ADDRESS E-MAIL CONTRACTOR C0,1 6 b 1 Z't-r. (soe S, 3•SCNii(EP a..- Gv ri�6 Gd. C own CITY STATE ZIP FAX -G .. Wit cies' IOS' 245e.,-re Y• Z 60-r WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M R TIAOC,t 'kb S g Cay. L t Z./ i / t1 (9 -`1$-AO }91_00-6, . NAME p PRIMARY PHONE IC Cr 4006 it-t4DUc'c fgvlcEj 2.e, •"r26' 09 4 O MAILING ADDRESS APPLICANT 6 06 (2 T1-F Aa�l , j r a E-MAIL aNeitLye?rri-t1ooCI,CO144 CITY F' STATE ZIP FAX SE}AIT W' Ct9 (C) 20(;,•.1 I.7 '24b7 NAME PRIMARY PHONE PROJECT CONTACT St NG-13 i....)1 ZO6. TZip (OS L.O MAILING ADDRESS (The individual to receive and €0i06 EMAIL respond to all correspondence eD i 0O [Z'l'' A ,'e-- S• J 6,,KELY e_ry-t-too 0,Ce,it/ concerning this application) CITY STATE ZIP FAX S6-A111.-C NAA 9 (Og ZOED•-no`r' zbo1 NAME PROJECT FINANCINGI\%%,...\ ❑ OWNER-FINANCED When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP f 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 t the city as a part of this application. �j SIGNATURE: DATE i D/(q l L o l PRINT NAME: \ki SeAks iG )• Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application