19-103089 A`R RECEIVED
�. JUN ry 2019 PERMIT APPLICATION
CITY OF 2 , ,T019
Federal WayCi 1 r`%+F FE L' PEST CENTER+33325 8, Avenue South+Federal Way,WA 98003-6325
.= 253-835-2607+ FAX 253-835-2609+perrmtcenterra;cityoffederaiway.com
COMMU i i Y DEVE!C"',";; -
PERMIT NUMBER 1 l 1 _ l _ r
fr
TARGET DATE ,i /7 -3. I C91
SITE ADDRESS 1.3 r701 P�_/ V o --' Gv\koc Ley. WY . SUITE/UNIT e
rAia0‘) , \Ai/A
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL II
$
CG - G '1 2 1 0 i#-- C'Iv,� 4+-
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING NI N'IRE PREVENTION
NAME OF PROJECT b1.-'j-- 1:::11 > -r- V ,1
PROJECT DESCRIPTION `J I= ..,1 I/�1
Detailed description of work to
be included on this permit only
‘Jhdeirillo0r1 r-e rt � i 1
NAME T 7 . PRIMARY PHONE
PROPERTY OWNERIVlICAfCI e1kr)Vp 00 1)�.1I•Si62.
MAILING C J ADDREESS� i PrL �J�}p�� E--MAIL ,,y_orH
'2V\1• C�J1 140 1 w M 1•' ` 'Y,tarlel
ton Mrvo ,
CITY STATE ZIP
9G.k-01 t'','e V4-1°C- 47i•2120 I cAm
NAME131 ` �wif�1 'E r SSW (4�1..KJ' o l 1
MAILING ADDRESS F•-MAIL
CONTRACTOR
47.(0- 1�x ,�1 Ja. b-) 1 b i19 i-mown-Fti'tee r}.i,..q�
CITY STATE ZIP
_ 1vf► -1 G IN JNA o►r3�02-2 ��' ��
WA STATE CONTRACTOR'S LICENSE a EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
o12-r'17 12-wi 7 /1 /Ial 2•0- 13- 1o?$ -c o- 1.
NAME PRIMARY PH NE
APPLICANT MAILING ADD SS EMAIL
PO' 1 w 1 i o►sor&ta_rov izz n-er ; c,2.M
tTY FAX
nU?Y C,ttWV WA z' iso T. -2 ,oc:3 •527
PUMARHONE
PROJECT CONTACT NAME V r'C N NAU 0�_. L L's�DY )—px)• 047
(The individual to receive and MAILING ADDRESS E
respond to all correspondence Po • i ) ,•`,--..1 -,6'116I-nou r}-ok1„eYr1:1,p4,
concerning this application) Cr, SWIG` CA k") STATE �ZIP 2 '
tin FAx ' ' _
•
NAME I h LOIN of i' V yr
PROJECT FINANCING t OWNER-FINANCED
When value is$5.000 or more MAILING ADDRESS,CITY,STATE,ZIPZI ���p i,�/� yPHO�y�PHONE
IRCW 19 27 0951 ,� ^ W C —-e 1 A.�J 7- ar E � 1 W) ��7�t�pl,� CM)"' 1)M I, 1�1'
I certify under penalty of perjury ytthat 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 defens • ch claim),which may be made by any person, Including the undersigned,and filed against the city,
but only where such clal arise out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t city •-a part of t is application. +/�
SIGNATURE: DATE (,/,' , 1" 1
PRINT NAME: • 1V micioR,
Bulletin'4100—January 29.2016 Page 1 of 2 k\Handouts\Permit Application