18-100185 RECEIVED
CITY OF PERMIT APPLICATION
Federal Way JAN 12 2018
CITY OF FEDERAL WAY
(-y COMMUNITY DEVELOPMENT
PERMIT NUMBER / 7 __ / /'� /1 / Q ` - fO
!J ((( (� V ( U ✓ TARGET DATE
SITE ADDRESS SUITE/UNIT#
3Soo Z PaoWi-c guy S. 4103
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 800 Df3 1 8' 5 2 1 5 - a o 5 0
TYPE OF PERMIT ❑ BUILDING 0 PLUMBIING 0 MECHANICAL ❑ DEMOLITION 0 ENGINEERING CO FIRE PREVENTION
NAME OF PROJECT The GioppCd LCa T
PROJECT DESCRIPTION Mad`& e x i S T I-613 / r�i JnfC iev Scysfee'1 'kr mew mei ot n t
Detailed description of work to 1 M�tpro IiC—z t+'i* WA,l(S0 ao,Cr cal Iry /GIGp‘ (4.f-
be
4 t
be included on this permit only �/
NAME PRIMARY PHONE
PROPERTY OWNER Fwd00•(41
/C:y Crosc8s
MAILIING ADDRESS
E-MAIL
35'O0 2 'aa'crc tiwy S SGIItC, 't1 03
CTY
r'Ite.- I WA. STATE t ZIP eoa3
Patriot - Protection, �NAME P253-926-2290 ADDRESS , 70th Ave E E-MAIL
CONTRACTOR
CITY Tacoma 'ATE ZIP FAX 253-922-6150
WA STATE CONTRACTOR'S LICENSE# 11
4E7�1UJ(PI TIO L D TE FEDERAL
BUSINESS
S CE
PTRIFP099CF
NAME � PRIMARY PHONE
DANi i OAr'i Stensor( 253 -224t0
APPLICANT MAILING ADDRESS E-MAIL I&wn,GAP Sten Ten
Same as above epat.torfrril•CONA
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Daveh C4r-ift&YSoh 2.S3"a2` -220(0
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence Same as above
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$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 ass a part of this application. / / D
SIGNATURE: lhi $_ Ci�j�S t 1 t DATE 1 l
PRINT NAME: Dew rel 64w-1St e..ySovl
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application