19-105372 RECEIVED
cin of A PERMIT APPLICATION
Federal Way NOV 0 7 2019
CITY OF FEDERAL WAY
/ COMMON DEVELOPMENT
Fp
PERMIT NUMBER / _ l O c 7- _ q, L
(((_q TARGET DATE
SITE ADDRESS SUITE/UNI
33i D u/ N -e,�.hcc�uS er Way S. ciEe PO /30
PROJECT VALUATIOZONING V ASSESSOR'S TAX/PARCEL#
$ (to,85.°o I 5 4 (o (o - O 0 3 d
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL El DEMOLITION El ENGINEERING Lrl h IRE PREVENTION
NAME OF PROJECT -�!� _ A1162 n 0 V" - `.
�� >s- '..moo-- - _��F
PROJECT DESCRIPTION i X .0' �-��� / . �/'.. :ii _ 1_ *l
y
Detailed description of work to adeeti X51...7)Pt„..i.es /7 . / _ �Rds �4]'7�'l.
be included on this permit only �/�q U �-'t-
Irvl .Zi C. 4 r_os -18
NAME P- M. -Y '..
PROPERTY OWNER M 1) �� /,:)fell t' /,ie'�'%T rr
MAILING 1E5cS '' / � ten- E-MAIL
CITY Ve �/1 _ inTit___
UUUZI 7,(J'/" ' _.. �..
NAME PHONE
Ayau-y btrv€-I-t . /ne. X53- 972 7222
MAILING ADDRESS r ,,/9 E-MAIL
CONTRACTOR 7855 S 2O1,11 S S . G0 //aeenaa,Glurekkwlratcn
•
CITY STATE ZIP FAX •G'l.ffY)
'032
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
11-1ZC.t-1-E1°4 2n z2 I a/ 31 icC Jo-oo-lot
NAME PRIMARY PHONE
//1 4.11 e �'eJ c-r, ('laL > 7755-8702- 7222
APPLICANT MAILING ADDRESS E-MAIL 464
CITY STATE ZIP FAX •UYY7
NAME i'I\MARY PHONE
PROJECT CONTACT AOIC A(t so i
(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
Required value of$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 tt ity as a part of this application. G/
SIGNATURE: '�sa!i i- DATE ///���f /
PRINT NAME: .
1fj Gal I. Ak.iso,