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17-105503
411/4 PER CiTY MIT APPLICATION Federal Way PERMIT CENTER+33325 8th Avenue South+�i 003-6325 253-835-2607+FAX 253-835-2609+perinitce e rz: r NOV 14 2017 - PERMIT NUMBER 1 _ I 0 55 v 3_ p — — — TARGET DATE CITY OF FEDERAL WAY COMMUNITY DFVEI OPMENT SITE ADDRESS SUITE/UNIT# 3(515 ?ate UOn F-e--ch bcw e.- Licy c, /®8 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 1* $ 9 1 500 C 9 �.- I o c f. - °C �/ n z TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING LJ FIRE PREVENTION NAME OF PROJECT t.,4 p U Peotal CA`n,--c_ PROJECT DESCRIPTION l� r� r_ Ce,fro a' M� co Hon /r(,&o f! - Detailed description of work to ( 3) �jfiW tZ fo e),r 3- NA I L- P©(ek- lei be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE ZIP NAME PHONE ham- proteLtaon gam-9V" --g .ao MAILING ADDRESS E-MAIL CONTRACTOR 7({47 6 :17410' Un) c(.+tle X 30 Irotet.trove ( aortal.C(YAi CITY _ STATE ZIP FAX CITY. Pio ce L4- 0184-66 de,-b&V, - (fe(it3 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# *HoUHr ' as / / .1..-11-1-0/4-0) --Co-6L- NAME PRIMARY PHONE -1 if kovw- eirotethoi APPLICANT MAILING ADDRESS - - - -- E-MAIL -q.O6 / :�-1-r+^ C�{ t (iv1tei#3oo (� CITY,`n) eViir fy 1710 -ce. STATEZIP /�, FAX `►"�I FAX ik NAME V 1. `1 l7 b PRIMARY PHONE PROJECT CONTACT (A 0 /�( -9 J-3 -' 337 (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX 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 attrn s' ees incurred in the investigation and defense of such claim),which may be made by any person,including the undrsigned,n a , but only where such claim arises out of the reliance of the city, including its officers and employees, u n information supplied to the city as a part of this application. NOV 14 2017 SIGNATURE: DATE PRINT NAME: A614y ( M CITY OF FEDERAL WAY COMMUNITY OFVELOPMENT Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application