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20-100399 A. . RECEIVED J A CITY OF �.�. N 3 0 2020 PERMIT APPLICATION Federal WayCITY OF FEDERAL WAY PEST CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607+FAX 253-835-2609+permitcenteri cityoffederalway.corn COMMUNITY DEVELOPMENT PERMIT NUMBER J () - 1 O 0 3 c m - )a._ TARGET DATE SITE ADDRESS # -SLI SO 5 SL L way fo v PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ `i6bd tenni(,-crii41 2 2 2 / o l / - q 0l 0 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING gi FIRE PREVENTION NAME OF PROJECT (1 p o (\ ��✓✓2e. t 0 CA 4-e- VA c►re S r,n kc Ce r 1re_a_851 i L d. l Z PROJECT DESCRIPTION f work t n , 3 c C Ck n• l OA r 0J(w-c r\ i- Detailed description o work to d P .� I� Q be included on this permit only 1 �J 1 NAME PRIMARY PHONE Rl-k EL, f iU AcSoc• l- L. C. PROPERTY OWNER ING ADDRESS E-MAIL o ( © A '1Se003 n G �{ CITY ke o v ` STATE W A ZIP - F 00 I C row r% ' ire- eco-Ver,k-i o�n -i Z s ` VIY1 (o 6 9 MAILINCONTRACTOR PO too V 121\3 E-MAILrfie @Crown--p-ctier) CITY FATE rh. l E Grp OR LICENSE r �`iEXPIRATIONg ?�P Li 2sFEDERAL ALi y 86 4 5 WA Y BUSINESS LICENSE# c_gow Nfe0(..11il..t.. t2. / 5/ /2,0 11-a14-105(.61-o° bt-- NAME ��.) n "ire fro 44-0 ^ PRIMARY PHONE APPLICANT \ , ` Stile Ar\e_ a 5 G�+b a J E-MAIL CITY STATE ZIP FAX NAME PROJECT CONTACT C Ci 5 11 Q. C la A.A. L/L 5 (17 ' 7 66, / (The individual to receive and respond to all correspondence MAnING ADDREeee 15 O Y Z 113 CI-1'511e fi,e G'c rex-)l�t•`'r? concerning this application) oITXf J l I (reG f _ LJSTATZIP c 0 CZ FAX L 5 4.� rn VG (� tI 7 1 7� NAME � ( PROJECT FINANCING N lzstA. 0 OWNER-FINANCED When value is$5,000 or more MAILING ADD ,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 p/arrtt ofofthis application. SIGNATURE: ,sctIA—,% I 0�z��iy DATE f/7 '/z 0 PRINT NAME: (�r i S i ' hi 0 1 f Q'1 Ci - Bulletin#100—January 29,2016 ✓ Page 1 of 2 k:\Handouts\Permit Application