19-105677 RECEIVED rEft KLiMii i AIL In"rLt16.111. i rural
CITY OF
Federal Way DEC p 2 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(acityoffederalway.com
CYC (EDEVELOPMYEN1
PERMIT NUMBER 19 — co 1 1 (-: P I �"
_ - TARGET DATE
SITE ADDRESS SUITE/UNIT#
32.ctot wEyE -H4Eusgrz_ l.✓Ay cu ri4
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 7IRoS C ( (o 2. I U y - R0 ! 3
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERINGFIRE PREVENTION
We NAME OF PROJECT :I/6-. -t j �
A � - �-f/t„c.5 en- co . •
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PROJECT DESCRIPTION Avv l T(o xf OF 2 A-1017 P I C-IA /-tam F l e( E A,C -(
_./v,,12/
Detailed description of work to l�� ��— 5C5S S /� 2 A Et n)JFEpij-P-
be included on this permit only S
,
NAME PRIMARY PHONE
VV6-tiel6RA6u, 'T/miaCO. i5-5-`12!-1-245
PROPERTY OWNER MAILING ADDRESS E-MAIL
3-10co ( WcVE12f{AeuseZ, WA y S aaaly•bylitig*.yerheteuserusM
STATEZIP
20.2.A,L mkt" (AAA cl goo 1 ,
NAME PHONE
JVrLGj, t 601-WOWGIES. LLC 4125--212,-22S0
MAILING ADDRESS E-MAIL
CONTRACTOR Lf SO S l-t.ATTUtK AVE S . 4 (OO clslie.p0n-lrlctkezaivu y Al-W
57e1-JTa STATEk geo57 ins-2s-1 -O 97
WA STATE CONTRACTOR'S LICENSE* EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
COIUVe-fl s 13( 1 le 20 ZO-o5-[oZ938-' 6-81-
E
1 V6 foi 14K
PRIMARY PR51 -331/7
APPLICANT MAILING ADDRESS E-MAIL
ysn SWMrru(K AVE s /0 da„.p.,,t,,,Aeempertr(;-'ear
OW, *MILAN ZIP FAX
Kt-Ai-roil kiii q605-7 y2 --151-.09 9
NAME PRIMARY PHONE
PROJECT CONTACT TX 1/g-` 7vr//VAK q25- 3 57 -335'7
(The individual to receive and /MAI
MAILING ADDRESS,/ AVE ,/E-MAIL A�
respond to all correspondence on FAX
S// L R Ag 4 krb O l ReQM, ayild P�
concerning this application) "`L/GN l� / SAA I .5_7 y25_,......26.7
_0141
0 L 41
71
NAME
PROJECT FINANCING ❑ 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 authorised 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 authorised 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.
/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 ,, 6i, this application.
?"i ' / DATE it/209SIGNATURE: / ��
PRINT NAME: 7;4 - ,(4/7-1L, '/