18-103148F� ' a PERMIT APP�JF ICON
lF 10 31 JUL 182018
PERMIT NumBER TARGET DATE -�9Ty � - FC tiYAY
— — — — — — — —
SITE ADDRESS s
TE/UNIT #
PROJECT VALUATION
ZONING
ABSE860R'S TAR/PARCEL 0
Ll _ 3 ® 2— _5
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
MWsA 6umv _ u
PROJECT DESCRIPTION
Detailed description of work toa
Alf PA 13 _ /Ale e tee%
be included on this pennit only
PROPERTY OWNERY�l
NAME
�✓� �I �" LLC
PRO ARY PHONE
MAIIdNG ADDRESS
2 2-1 _S 3364h Sr
E-MAIL
CITY�pp
D
STATE
2IP
NAME/ ,
C '� �rG`
PHONE
MAII,ING ADDRESS
5 �Q
E•MAD,
CONTRACTOR
CITY
ATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
1)LUi T_ 2m --j2-/3/
EXPIRATION DATE
i20-01-
FEDERAL WAY BUSINESS LICENSE #
00 -
S OG- 9L
NAME'_ G L
2 af��
BEAMING ADDRESB� T
N /rat �I
APPLICANT
CITY STATEZIP
y�
�°/� 6:' a
NAME
PRIMARY PHONE
PROJECT CONTACT
1
(The individual to receive and
MAILING ADDRESS `u LIT
(� 7
E-MAu,
respond to all correspondence
Tp
FATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(& 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 of,Yicers and employees, upon the accuracy of the
information supplied to th�ty as apart of this application.
SIGNATURE: /i"O� DATE (2111,0 �
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Bulletin #100 —January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application