18-100686 RECEIVED PERMIT APPLICATION
CITY OF FEBederal Way2 2018
FEB PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY F O cW F$&-(C'/
(�
U _O jhTYO DEVEzPERMIT NUMBER / lo / _ E
/
TARGET DATE
SITE ADDRESS SUITE/UNIT#
303S-1-4 PArG(cIG r&l'&/A ' sOUV%'t ,Fer)64 t-t, wfY, ufk
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ ?o srz> 7 8 C 3 6 0 - c) z- z C>
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING EgFIRE PREVENTION
NAME OF PROJECT LTC JA ('0;1)t Nks
PROJECT DESCRIPTION -0 aecS A F t( ke�c.-. SYCII
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
L,T C A L L-C
PROPERTY OWNER MAILING ADDRESS E-MAIL
29 -I2—1 \- s,
CITY STATE ZIP
n5,s\o/N3
NAME PHONE
'LA , ilZS3-22S-602X
MAILING ADDRESS E-MAIL
CONTRACTOR Pa oox geo,4 ev0.h@ 1(.1)LLC .cotitn
CITY STATE ZIP FAX
VPC<ki a IA 6-7
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
16(14 111 k eZ r OS/ N /0cl
NAME PRIMARY PHONE
E VA+) (2-Kg tfc ZS3-22 -60Z-C
APPLICANT- MAILING ADDRESS E-MAIL
(70 (.t< vtl�Q c�vo4A16 t7 0-
CITY
CITY STATE ZIP FAX
X110/(0/ wA Q.gOZ
NAME - PRIMARY PHONE
PROJECT CONTACT 'J ' QAC g€t6VS 2 �i-77-s--402c
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence F0 g ch1 c9 v'4 eac,e (b D t,LG.C9vk
concerning this application) CITY STATE ZIP FAX
Vi/SVNU rpt>\14 00-70
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 • reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a p• a••lication.
10i
SIGNATURE: 4 I Ott
ine DATE Z
PRINT NAME: 0•-•1\A4'1 C--O€ I
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application