18-100061 RECEIVED PERMIT APPLICATION
., PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607 +FAX 253-835-2609 +permitcentern,citvoffederalway.com
JAN 05 2018
GCITY OF FEDERAL�.�/ WAY
PERMIT NUMBER O CO UYY'EE9PM( , _ f
V _ /- TARGET DATE
SITE ADDRESS SUITE/UNI #
3 36 s . �/D
2OJECT VALUATION„ ZONING ASSESSOR'S TAX/PARCEL#
$ o (X ZC S^ C( 6 - Q ° q
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING OFIRE PREVENTION
NAME OF PROJECT cmc 60est /06-4(y C-e /- v
PROJECT DESCRIPTION /// /"��® ht �r-v se,Y�1I �n (
Detailed description of work to SLkt CZt i C-I of c/7QL /tc90/C�l ee fi�h
be included on this permit only ^ co
NAME /{� PRIMARY PHONE
lj%."r V2 ,f( 161 Ch1
PROPERTY OWNER MAILING ADDRESS l 7 E-MAIL
�6 ?Zr / fG74' A( /t $ t /oe.
TAT E ZIP `� P ONELyA5en 0 0-rc' r � )01-
NA)
�fye• SQv II��5 (Hia613ev- I�'`'1
MAX ING ADDRESS E-MAIL^7 � /
CONTRACTOR Q J / Acrd?Q,s( h k'/ 462.7/ ;Yocdr1
CITY ,I f.J pig ZIP1 /ip aI FAX
STATEWA OEETC LII •CENSE
'#_ 1'/ v/ 6 EXP/ ��NDA�IT9 L iE 6 �flP
N$63O^7rLICENSE C6
NAME PRIMARY PHONE 1((_S
Sa MJt
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAMEPRIMARY PHONE
PROJECT CONTACT � v-o t 13--I S
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING Ef OWNER-FINANCED
When value 13$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
a.27.nvil
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 t.. old rmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred in
the investigatio •nd defe se of such claim) ich may be made by any person,including the undersigned, and filed against the city,
but only where ch cl, m arises out of h' reliance of the city, including its officers and employees, upon the ac uracy of the
information su,p ed • the city as •pa, of h' application. \
SIGNATURE: DATE
PRINT NAME: n
Bulletin#100—January 29.2016 Page 1 of 2 k:AHandouts\Permit Application