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19-102932 RECE . ,.. 1 2 9 PERMIT APPLICATIONS CITY OF �"� JUN1 2 ' PERMIT CENTER+33325 8thAvenue South+ Federal Way,WA 98003 Federal Way CITY OF FEDERAL.Vd;';! 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com COMMUNITY DEVELOP ;i x I PERMIT NUMBER I 1 _ 10 -2_. 5 3 2 - F p TARGET DATE ��A SUITE/UNIT# SITE ADDRESS 44,v1 , 20 2 0 3 zo 114 S7` . PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# ^ ` 2oo-o c $ c c 0 7 -z r a - ? 7 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING IX FIRE PREVENTION NAME OF PROJECT E^ t /eiSrQ Znxt u' 41 oa fi r42_ S G/ ' ,'slur rre-iet _PROJECT DESCRIPTIONH / ��e i:�a/,1 jc per> � : / ?•-• 3 7,P-Duff 6-- be description of work to O� be included on this permit only _ PRIMARY PHONE NAME iAl C c Gr- kii-a._ ZZC___ PROPERTY OWNER SLING ADDRESS E-MAIL CITY I STATE 1 ZIP .. - - - _ - - - -. - - ._ _ _ W� PHONE` _ NAME Fra/' Frs p7e- P41ri /t 0-71._ 7-0V 77? 9-] MAILING ADDRESS E-MAIL SS CONTRACTOR 21( /7 /4-v 44 SE CITYSTATE ZIP FAX K.--4 -- vA 7J o 9-Z WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# -.R,4N/CFP7�Cr'C0 / / _ NAME ^ PRIMARY PHONE Davitd L-e #2 - G-.Pif‘oJ'/ ADDRESSMAILING E-MAIL APPLICANT 21 2-r5. W 20o-4.1 ��' Ce eW%0 4S/© /, j CITY A I STATE I ZIP FAX ` WA_ Il f )/7-7 NAME PRIMARY PHONE +��/�) / PROJECT CONTACT , t euv i ` MAILING ADDRESS E-MAIL (The individual to receive and SM 4 — respond to all correspondence I STATE I ZIP FAX concerning this application) CITY NAME �I OWNER-FINANCED PROJECT FINANCING PHONE When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP (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, uses,and attorneys'fees incurred in expe 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. `- DATE 51; /��� SIGNATURE: ��� PRINT NAME: IP' 'l d -e_ Pae 1 of 2 k:\Handouts\Pei Bulletin#100—January 29,2016 g