19-102476 . .
,A. RECr-- PERMIT APPLICATION
CITY OF
Federal Way �1PEST CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
MAY L 2019 253-835-2607+FAX 253-835-2609+permitcenter�;cityoffederalway.com
CITY OF FEDERAL Wel AY
PERMIT NUMBER F- (33. p1TARGET DATE ��
SITE ADDRESS SUITE/UNIT S
39 7a'J PAucl.e_ NiGU(A.A-y '1H Ro6/2-m_iii),+7/adyt q.ceg
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL I
$ Saco,00 - — — — —
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ENGINEERING PIRE PREVENTION
NAME OF PROJECT VCA VO I i et-C__ FE oerL i t!J m-7'
PROJECT DESCRIPTION i ftStcv(Ac..k1 ea (�C r P Lk) c--1 re_ 4JGti r r''1 5 ySkt/h
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME11 PRONE
(*St Cor if etedree4 service S
MAILING ADDRESS / _ E-MAI.
CONTRACTOR 1• c 7 myam/// Sfk "� /o__
CITY STATE ZIP FAX
ihflOSOD WA- 1;067
WASTATE'`
CONTRACTOR'S LICENSE 0 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE it
4/e4f Ice- 89.7 p6t 10 1.20 /I q
NAME ` .� PRIMARY PHONE
�r-c,vor r4cr1 LeAS-- 5-4,3-`!/Oa'
APPLICANT MAILING ADDRESS E-MAIL
12-cai 441441kreelie-vti /0 7' -i-revGr G,�f'elR tteils,fU'"�!CITYA//iUeoA . ZIP FAX
FNI
C ims--33z- 3g-a 9
NAME / PRIMARYc A�RY PHONE
PROJECT CONTACT `Tr-c,vo r kr A i--14-t-
-�f %1 .. SG 3.. `J/O , -
(The individual to receive and TING ADDRESS E-MAIL n
respond to all correspondence 114-2"i wt 61Z l I�-CO iv /o �re 11 D✓W A)C e�t dna or?'
concerning this application) CITY STATE ZIP FAX
L hrfwo6/ tot 9go 7
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 rt of this application. C}/
SIGNATU DATE 07/l I
PRINT NAME: -M. U D l 14, s c wfi
Bulletin#100-January 29,2016 Page 1 of 2 k:\liandouts\Permit Application