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18-104972IL -77-1 ' REC� ED. OCT 2 2 2018 ' .. PERMIT APPLICATION CITY OFCITY OF FEDERAL WAY :f. C rc yMMMUNITY DEVELOPMENT PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 3� 253-835-2607 + FAX 253-835-2609 + permzcenterii!unoffedes.ahaa� .com PERMIT NUMBER - I 0 � � -7 -Z - � TARGET DATE SITE ADDRESSE/UNIT # 3H alo 9-V 1A L 5 71.10 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # $ 1500 . av Be TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING XMRE PREVENTION NAME OF PROJECT W ? t). A% 7 Abbs L)0-5 L N6 i AIV Ar w PROJECT DESCRIPTION Y Y W v, hLrl s v6 . Detailed description of work to be included on this permit only NAME PRIMARY PHONE CABG - A ,-� LLC.. PROPERTY OWNER MAILING ADDRESS E-MAIL I UACO J 5T -Jc1,700 CITY STATE ZIP 1)051 0 "V /1A k I a 1' i NAME PHONE i-rN STAU,5 FAL 0 J.1ION 9 5-1361-0100 MAILING ADDRESS )y 90 Ak, WS1 R'S # 10 E-MAIL CONTRACTOR CITYSTATE KLb"'O'vo 1�/ ZIP q`30 FAX I -)a5-'6%1 -3031; WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # Wf 5Tp5F90 Il ► Iii -99- ^b'1%--©o--5L NAME PRIMARY PHONE MAILING ADDRESS P-16 0 9� A r Ic E-MAIL SEiH. ZLN,v��a WSFP �s APPLICANT CITY STATE ZIP FAX DMoN4 *WA %off `1�5-8�►-3v3v NAME S PRIMARY PHONE �ia�-1 PROJECT CONTACT k I ti O MAD,ING ADDRESS E-MAIL (The individual to receive and respond to all correspondence Jq690 AJF qSJV%J1 itlot 509, 26N/o MID WSPP-J S CITY STATE ZIP FAX concerning this application) RL WA %6'). Li) -s -5g1-3030 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 as apart of this application. SIGNATURE: y^� '-'-- DATE 0` - 0 ` PRINT NAME: AJ DLtL Bulletin 4100-.Iammn 29. 2016 1'aiLw 1 42 k:AI landout.)APermit ;lpplication