19-103044 RECEIVED
CITY OF �-�- , ;a,(� iU�,�.;9 PERMIT APPLICATION
Federal Way PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(acityoffederalway.com
COMMUN i�' DC iryLOPMENT
•
PERMIT NUMBER /2 _ L o z Ov �iLLL - P TARGET DATE
SITE ADDRESS SUITE/UNIT I
3290 1 W Ey E12.-HAEOSER- Wray , f e- —iL- wily, w6 9600(
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL I
$ 141.I50- DO I 6 L I - q 0 1 3
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING%FIRE PREVENTION
NAME OF PROJECT .
A[`ST Fu M E "°°9
All P E P-
/N1 TE2fvA�+i on1AL
PROJECT DESCRIPTION WE A2.E ADP(1.Dv .4- AUTOMATIC FIRE SvPP,EssioN sysI5f'1
Detailed description of work to TO /t FaM E /tool),
be included on this permit only
NAME PRIMARY PHONE
INTI 11,2R-r,0AM L WIPE-32_ 253- /2t/•(o235-
PROPERTY OWNER MAILING ADDRESS E-MAIL
3280 I W EY,EP--IiIGJsF(l-- RAV S anoty, bylinrZ vJeyetheoser
CMT STATE ZIP ``
?COeNAL v\) AY WA 98"00(
NAME PHONE
I\t U)(kG( (9o0 (CC& Fg,,,,pnio + 20G 432 2&IO
MAILING ADDRESS , E-MAIL
CONTRACTOR 1456 N W S3rsi- 3iarcia 0 6e,4-C,re..,,o,,,,
7e704*
eos le STATE
W R '810-1 FAX
WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE I
ALExACrFo47N(A) g / /(a / /, 24- 0- 101sas-oo-iL
N PRIMARY PHONE
�sk1vA &pact& 20(0 -632- ZliO
APPLICANT MAILINGADDRESS „e„1, S i
1 . ( , s.` Q a rc,Q p U p,3.ei re,,,c M
STATE F
SCVk eC � MO-1
NAME 22 PRIMARY PHONE
n
PROJECT CONTACT C'1 n P y l CO
(The individual to receive and MAILING ADDRESS E
respond to all correspondence 3290 1 (Ni'e y e( \161e u ser W d`^/ S Q ,by I rn(4 w e ye I'h 4 etc.
concerning this application) CITY STA ZIP FAX
Feokeral wa-Ai w 8800(
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, expensesand 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 -rises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information suppl — th city as a part of this application.
SIGNATURE: DATE I lUI
(d.)
PRINT NAME: ‘q\1)\ (9(c-U41/4
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Pernvt Application