18-102288RECEIVED
r MAY 29 2018 PERMIT APPLICATION
CITY OF
�%�� FEDERAL WAY PERMIT CENTER + 33325 8� Avenue South + Federal Way, WA 98003-6325
Federal Way � M N g tO Ei� 253-835-2607 + FAX 253-835-2609 + permitcenter(a;citvoffederalway.com
PERMIT NUMBER _
I D TARGET DATE
SITE ADDRESS V \.VC �+aCh
'ZISkKKvw..
SUITE/UNIT #
'36-030
Fectev k IA q 000 3
.PROJECT VALILATION
ZONWG
ASSESSOR'S TAX/PARC #
TYPE OF PERMIT
1_1 BUILDING . ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING)<FIRE PREVENTION
NAME :OF PROJECT
O k k ve- 6w,4LOv. F` we Akavm'. I t'J rad P
Y� v,- 9- ew- U u -LC
PROTECT DESCRIPTION
Detailed description of work to
be included on this permit only
.NAME .•°
e d�1rlk ?ro ;kI'�,) =v.G
PRIMARY PHONE
63 01 S7 1395
PROPERTY OWNER ....
MAUUNGADDRESS ..
35d30 E„�►o.�..tccl �kwR S
E-MAIL ~
CITY
Fcae—k,
STATE
to
ZIP
8003
1AICaE- -
PHONE
aZS3 7 b - "7a 3
MAILING ADDRFSS M1
CooZS� (o .'.;14ve s.
E-MAIL
elvlha.tgxter• •ci.toi
CONTRACTOR
C=
w
ZIP
zIPq�32
FAX
29b ' 7-�b7
WA STATE CONTRALTO 'S LICENSE #
3-0*14 scs �3_,N
-- EXPIRATION DATE
�aU
FEDERAL. WAY BUSINESS LICENSE #
1 - s S' 6 -00-�
.NAME - ♦
PRIMARY PHONE
APPLICANT
MAILING ADDRESS Lj C t v Iy 1
•j,
E-MAIL
CITY
.STATE
ZIP
FAX
PROJECT CONTACT
NAME
C. (.Jl v'%k %� R x 'ev'
PRIMARY PHONE
0_53 % 7s2 3 44
MAILING ADDRESS h,/
i Cl &a'S �� :7 '"` vC
E-MAIL .
C�V.~K.be sten •�� •ca
(The individual to receive and
respond to all correspondence
CITY
keKk-
STATE
wA
ZIP
D03'.)_
FAX
' 7pZlo7
PS3 7q6NAME
concerning this application)
PROJECT FINANCING
bKr,.eVJ7.�S�KM/PN�S (►�C CSr.
OWNER -FINANCED
When value is $8 000 or more
(RCW19.27095)
MAILING ADDRESS, CITY, STATE, 21P _
3;0307 Er.eGwy "Rt Pk,- &U4W
PHONE
V15' 1375-
I certify under penalty of perjury that ham the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in supportof 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.
a City of;Federal Way,as to any claim (including costs, expenses, and attorneys' fees incurred in
I fu' rther agree to hold harm�se—_�!ti
the investigation and `defense oclaim),
which may be made by any person, including the undersigned, and filed against the city,
but only where such claim of thgreIiance of the city, including its officers and employees, upon the accuracy of the
#nformation suppled toity
'
apart t application.
r
J/fig
:SIGNATURE:
DATE
L
F r� w e
{ye W.',
PRINT NAME:
Bulletin #100 -January 29, 2016
Page 1 of 2
k:\Handouts\Permit Application