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19-102775 RECEIVED A,„1,__ _A..... �, PERMIT APPLICATION CITY OF JUN 9 1019 Federal WayPERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 fy�. �;`�._ : , 253-835-2607+FAX 253-835-2609+permitcenter(a),cityoffederalway.com OMMU NITY DEVFLCPMEN7' PERMIT NUMBER j % _ so a 7_75 EP !!! / TARGET DATE SITE ADDRESS(�\' \_ SUITE/UNIT 1i ^/'�� ,,02-6\r‘) PROJECT�ALUA��N S5��\ZONIN`Gp, ,4 ASSESSOR'S TAX/PARCEL 1 gm, �, �J C $ 1'2i 00© S CA o - 9i 1 a TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ,FIRE PREVENTION NAME OF PROJECT N OVA.\\ oye -eIC (3�t V PROJECT DESCRIPTION \-0\A `j e\ a — C l V 1,U{ c t t Detailed description of work to be included on this permit only _LL NAME . . _ PRIMARY PHONE PROPERTY OWNER fi bi) S _ D V F ( MAILING ADD• i,/� E-MAIL V CITY 41T A. ZIP NAME PHO £ING ' \ it u 1 eADDRESS / E-Vis— 33 7 )717 CONTRACTOR • n DQk "'� 3Ciet s©f oal greprlly-try V i CITY FAX s- 5�5_ SI 2_ Ess WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE ERAL WAY BUSINESS LIC E li SA c� Ai. V M� 7 / t / �Q PRIMARY\c- %r i --m-f1, 5 1qr �c�ec�nn�o\Ojs`' 537- 3 APPLICANT MAILING ARDRESS E-MAIL tCc C\S i 8 TE FAR \fill t%1010_ , ___ _ i NAME PRIMARY PHONE ` PROJECT CONTACT q(\t\f c 1) \ (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME PROJECT FINANCING 0 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 authorised 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 authorised 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 a part of this application. r SIGNATURE: —....6...-_----__------- DATE S �)/7/ q I PRINT NAME: r? i ° 't �li r Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application