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19-104515
„,,,....._ ..A. RECEIVED PERMIT APPLICATION CITY OF Federal Way SEP 19 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com CITY RAL WAY COM UN( Y DEVELOPMENT PERMIT NUMBER / 9 _ 1 D y 5!5 - Fp TARGET DATEC . ...3 SITE ADDRESS SUITE/UNIT# 3LlP6 . l (-' ' (Gce , le-de-ref' WAY Aqs©o3 PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL# $ '3T 0 0 - — — — TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECTr/0 – C__.��f a 65 PROJECT DESCRIPTION Detailed description of work to F- ” P t , (-. be included on this permit only _ NAM .. . PRIMARY PHONE 1r- IL A)crvi Le- PROPERTY OWNER MAILING ADDRESS cE-MAIL CITY , STATE ZIP NAME sty COIM- C aio ( l 7\ PH / E / ' U -57 17 MAILING ADDRESS �{�, E-MAIL CONTRACTOR v N-' - CITY STATE ZIP FAX WA STATE CONTRACTOR'SLICENSE#/ � EXPIRATION DATE FEDESINESS LICENSE# - NAME3/ CAS f` PRIMARY PHONE APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX r PROJECT CONTACT (III-) Ti� r•R P PI .. �7 -5-09‘i (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX PROJECT FINANCING NAME 0 OWNER-FINANCED When value is$5,000 or more MAILING ADDRESS I TAT ,ZIP//\7— PHONE (RCW 19.27.095) V 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 rel nce of the city, including its officers and employees, upon the accuracy of the information suppli - o the citya`s a p• o this • •plication. SIGNATURE: DATE (7--- ` l I � 2 RINT NAME: ' C p0 , - Bulletin#100–January 29,2016 Page 1 of 2 k:\Handouts\Permit Application