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17-100134 ,,,„,..,4_, Ka*MD PERMI PAPPLICATION CITY OF Federal WayJAN 1 0 20 17 PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com CITY QF FEpeaugglif PERMIT NUMBER / 7 _ / 7 3 Si - C 0 TARGET DATE SITE ADDRESS ! SUITE/UNIT# '3c)Lp 3 pG,i' J i'c. � 5 PROJECT ALUATION ZONING ASSESSOR'S TAX/PARCEL# TYPE OF PERMIT UILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT "/ TA e 1441 r2 join-)—_o(nr PROJECT DESCRIPTIONdi b a In.La I P-12- `.11,- -- Detailed description of work to be included on this permit only -- - -- - N �5i// rh11.4" ` PRIMARY PHONEPROPERTY OWNER MAILING ADDRESS E-MAIL --)'\--, b....4_,...e....c. CITY V STATE ZIP -- --- - NAME .. —.-- - PHONE MAILING ADDRESS E-MAIL CONTRACTOR CITY STATE ZIP FAX ATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# __ _ _ / / X6-1/7-35 2 _ NE APPLICANT MAILING ADDRESS C•I► E-MAIL 9, 1-i ]ViC.41,2Sait) 64- Migok MGtikin2seleCandjx4.,i, CITYY .�+� STATE ZIP FAX ,..ICr' I )C wit!}- -I QO¢/ ° C dry' NAME PRIMARY PHONE - --- -l PROJECT CONTACT Maw k J c 4,1 it.) (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME -- - -- -PROJECT FINANCING 0 OWNER-FINANCED When value is$5,000 or more MAILING ADDRESS,CITY,STAT �! PHONE (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,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: /'ILDATE I/10 11-7 PRINT NAME: I� 0/47L- NIVICI.114 Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application