18-101221 RECEIVED
4. 9 PERMIT APPLICATION
Federal Way MAR 1 9 2018
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER , $ _ p 0 I _ r- P)f-
_ TARGET DATE
$ITE ADDRESS3 cf S"// p4cc:C
1,,f . S Fedemi�4/ y-DSUITE/UI4IT W�
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 57336 . 0 o l 6- 2- `l c - D O 7
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERINGAFIRE PREVENTION
NAME OF PROJECT /M'l C 1)0 n l,¢*/I,s o 4" `1030 j 4?
- pett
/ZeJoc44l.�y &y. ' e•-•
PROJECT DESCRIPTION .-�-• F [/. �� �� , t/c ��t,P ����
Detailed description of work to / o W Y4n� r/ l /tF ) J
be included on this permit only C'e> 111 LI !� D t c'1 I K !?� • illit) a e .2- 3
0� oSc Ll e4I$ li /4 • 15 , RaLed.
NAME / / f ® �' ,( T PRIMARY PHONE ]�
PROPERTY OWNER f CAO 41- 6/s /Pe4./-/�'f/ice ✓/ , 2°-Il/o 8430 i✓L
Q
MAILIN7T Aci /(r 1 �+• E-MAIL
CI mal to STATE
X9C O 3
NAME �aMf5 i`Ae 275=15'6,3 to0,
--~ m Ail AR,. y'71*-444. S . E-MAIL
CONTRACTOR
Ooi}hLi;itf r „reel f� 9�'�i-3?y3
uW SRAgR'S LIj$ _ U .- -,23/EXPIRATION/1?
1 DATE
FEDERAL WAY BUSINESS LICENSE#
/SINAME ��Q nG`d 561111,2/
0 P�S :7 #- 4-.6- q
APPLICANT
MAILING ADDRESS ,/f�0 /}!� (�c• 1.4 e/,3,,,,.,„sta.t 1-;11.1
CITY STATE ZIP FAX 5 a&v. am. Co IA-r
NAME/es I1( � ^ U _ _^.. .
PROJECT CONTACT PY j-h0(11
(The individual to receive and MAILING ADDRESS 5/ g E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME X OWNER-FINANCED
PROJECT FINANCING
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 cla - - out of the reliance of th ty, including its officers and employees, upon the accuracy of the
information supplied to •- a part of this applicatio
SIGNATURE: / ' DATE / /7—ir
PRINT NAME: ,eel /J t 5/9/1121#0
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application