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18-10463941k CITY OF Federal Way PERMIT NUMBER ( i _ RECEIVED OCT o 2 2018 PERMIT APPLICATION PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 O TY OF FEDERAL WAY Y DEVELOPMENT 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com C fF TARGET DATE �( SITE ADDRESS ,OVO1 o Ynec- Pvj / f SUITE/UNIT # PROJECT VALUATION $ fg U� ZONING AS SOR'S TAR/PARCEL # Q 1LZ TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING tIRE PREVENTION NAME OF PROJECT ` O l PROJECT DESCRIPTION Detailed description of work to O " �^ be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE I ZIP NAME '? ��- PHONE r.�- `n 6,4,22 Y5 MAILING ADDRESS E-MAILf:7 CONTRACTOR © ✓e- tl Y, "rd CITY STATE \Y•V I'w` Z FAX WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE 07-12,0 i FEDERAL WAY BUSINESS LICENSE # NAME Q PRIMARY PHONE MAILING ADDRESS 2-5 - E-MAIL y>7ri �C Lr Y APPLICANT- CITY c e "7 STATE ZIP �D FAX NAMEy PRIMARY PHONE PROJECT CONTACT MAILING ADDRESS E-MAIL (The individual to receive and respond to all correspondence CITY STATE ZIP FAX conceming this application) PROJECT FINANCING NAME ❑ OWNER -FINANCED When value is $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 claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city a7art ojthis application. SIGNATURE: � DATE PRINT NAME: Bulletin #100 - January 29, 2016 Page 1 of 2 k 4landout0ennit Application Lk w I