19-103923 RECEIVED ,,
Faders way AUG t 3 2019 PERMIT APPLICATION
Cf7Y OF FED-RALwoF
CpMMUhNiIY DEVELOPMENT ff PERMIT NUMLER ) ci _ , 0 �7 q 2 3 - II+-
TARGET DATE
SITE ADDRESH SUITE/UNIT#
55 tOc) inGnax\-(-e,c` l L )yS. Ve_d.i u-e.1w , W IA.
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 7,356 2_ _i_ n„ . St - __ ti
TYP OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING BeFIRE PREVENTION
NAME pF PROJECT C O 61c4, Who/esai .
PROJECT i)ESCRIPTION ` ' �/um' fLj
n c ishri
'- �i �6 ArAe SFrri.7k.1,gr r;t�k r,.
Detailed desc iption of work to U
be included oh this permit only
NAME PRIMARY
•
PROPERTY OWNER 6061C0 Wholesale. d aroyethe7'j 4Z5-3/PHONE 3-8100
• MAILING ADDRESS EMAIL•
l
ill Lecke- Detre
CITY STATE ZIP
/6Sn�t,ah wig 9802 7
N PHONE
(�`,nshr,chan inc.. 253-872-7222
MAILING ADDRESS E-MAIL
CONTRACTOR 7855 S WO 411 86 k'leker iearrher.eenr ietWn
CIT<en f W I A Z'fo 32 FAX
WA STATE CONTRACTOR'S LICENSE* EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 0
Pig.1451 '2.111 i.. /0 / 3/ / ,4 2o-oo-lot4(03-oo-EL
NAL/ . Ndsolnl PRIMARY
S11-fes 12
APPLICANT MAILING ADDRESS E MAD
5 S 2001 cStknege-n®ardne,r....
CITY,/ STATE ZIP w et /8032.03� •
FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAnA16 ADDRESS E-MAIL
respond to all correspondence
concerningthisthis application) CITY STATE ZIP FAX
PROJECFINANCING NAME 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 9.27.095)
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,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.
SIGNATURE: ilige-7/,‘ DATE 8//3/00/i
PRINT NAME: 'a-ht Ate/On
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application