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19-104847 izItoi v.ED ,A, oci a -1 209 PERMIT APPLICATION CITY OF OF FEDERAL v;E. T CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 Federal Way ccomMUN�pEVE�-D' 3-835-2607 +FAX 253-835-2609+permitcenter©cityoffederalway.com PERMIT NUMBER / -/ -. / 0 t! Y / -! / vv II-- TARGET DATE P „...' 4- SITE ADDRESS SUITE/UNITY 3 0 (Z\ �t-6�1 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ Lk't tk1 CI_” GI a O l 0 0 - Q c ,. U TYPE OF PERMIT 0 BUILDING 9 PLUMBING ❑MECHANICAL 0 DEMOLITION 0 ENGINEERING itFiRE PREVENTION NAME OF PROJECT /Ir`l�VN/( UkZ PROJECT DESCRIPTION F Detailed description of work to �1 , a A(-N( \) (\�,1 ury\k- (D tom ey , be included on this permit only- N Y I., ` � tit:- CIL _ NAME �' PRIMARY PHONE )1\1\ (\15A10 CAl0 If\ (II OLW PROPERTY OWNER MAILING ADDRESS E-MAIL Ur)D' l' - 7)k- AV\ Yob vAaCc , L�.e ,.0 -cpm _ aaxlIAME �� CI�C� p HO(. NE L61%;--394-ke MAILING�ADDR p p CONTRACTOR l J ` e -� (( �y k (4101\ CIP A STATE CONTRACTOR'S LICENSE i IRATION DATE FEDERAL FEDEZAL.WAY BUSINESS LICENSE S AME PRIMARYPHONE MAILING f�\�(t?_�.TL7C�,kY\�v\ . cf-t - 9tQ APPLICANT- `.- 1 " `$— A_WC , , �L GIYNC�V\� . CITY ��� cmc��� AMS RIMARY PHONE PROJECT CONTACT n�\Y'Q�Q YC,�,k\C�w�'C\ �( � Qtr,- ,�'4p (The individual to receive and -�A(IL G ADDRESS• L _ respond to all correspondence \1 3 ` 7\V C_'� (Vit c( is concerning this application) V IP 0 in I � PROJECT FINANCING NAME 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 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, 1114k , -7 t SIGNATURE:\ 1 1. ?(\ i DATE `l�( t l C �!PRINT NAME: Awl � l , _ v. ` Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application