20-100768 RECEIVED .
FEB 21 2020
CITY OF
A PERMIT APPLICATION :,,
Federal WayCITY OF FEDERAL WAY PERMIT CzWIZR+33325 8t Avenue South+Federal Way,WA 98003-6325
COMMUNITY DEVELOPMENT 253-835-2607+FAX 253-835-2609+permitcenterCdicityofFederahvav.00m
PERIIRT NUM3 R a V _ J 2. 76 .8._ _ //O
TeRi1ET Den (---------_____)
BITE ADDRESS SUITS/VEIT I
3Ll5b9 '1t i., $. ktiara.( w A I goo3 ►� IA-
PROJECT VALUATION ZONING A88E$SOR's T •
$ If 00D 7 c2 4- 5 I - 0 O L
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING *IRE PREVENTION
NAME OF PROJECT CV&S 1Z-62.414o L CI C..e INIe h-{' '- cat Kt)\ M O2
PROJECT DEs9CRiPTION 12(,1�l1 it 6E_ -�t[;L.ei i94 to i o (N1 i-61st �
Detailed dem of work to
be included on this permit only
NAME PRIMARY MORS
t . .g4509 00 Phu? W.406 I-1-e—>' LI iy -7 65'53
PROPERTY OWNER > o uE-MAILI-JO �� & i Ie 4-° r1
s
arrr ` A , ,ta- n
_
4p. 453. aa,V�- etg° 4
( ZYVie �f T-cdii QS L( C�
MAILING
S - u Cit- c� . a+ C 1j
fR
C17T STATE EW AS
}ZPiY h)� -VIA— '1 51 ({)y ir[v-1.-44. •Lt
WA STATE OORTRACTOR7t L1faNSE• EXPIRATION DATE FEDERAL PAT EDSDIEUS L1Ci-R• ,t-''
/ / ` sX,
SAILB PRIMARY PIIONE x 10
Tt w.f` 95y144 414 pl/ujicittyt) 12ca-t.t9Tvu, - Li t9-...21.0-1, �`4t4.11,
APPLICANT `'
11 1 YK a AIrf. &4c -�S€ care i+,t vv f.
C11T , j ,�^' w ' 6T/�R— ISIt'1 4 'Aa , ,
PROJECT CONTACT VA' SY14i1 -131 a!L ( o,,,,. t ,
(The individual to receive and
MAORI°ADD /� C ILWAI d i
respond to alloorr,espondenos I O �� V t tri 11►"�. 0[M - -1-t a @ a or.re T-.c vi,%' 'r'
,( /TE ZIP y.- g (x/,�/// h
concerning this application) 11A- IA/f _ U 1 O� FAX
IAMB
PROJECT!MAIMING VC owNER-rnm
When value is$5 000 or neat MAILING ADDEZIM CITY,STAIN,UP Poona r q
. !x
(RCWh9.2Z0As) /V.v-7 "-` '
I cort4fl under penalty ofpe ry that lam the property owner or authorised agent of the property owner.1 , w
a.tvy that to the het
of nue knowledge,the information submitted in support of this permit application to true and correct.I wring that I will comply voids 't, 1
all applicable OJy of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that tine
issuance of this permit does not remove the owner's responsibility Jbr compliance with local, state, or federal laws rsyrtiatirey , {
construction or environmental laws. 4
I further agree to hold harmless the City qf Federal Way as to_claim(including costa,expunges,and attorneys'fees incurred in :V"
the investigation and defense se of such claim),which may be made by any person,including the undersigned and filed walnut the c t i
but only where such claim vises out of the reliance of the city, including its officers and employees, upon the accuracy of},h, , v. r;I
information ation supplied to the city as apart of this application.
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SIGNATURE: •`7' �- `- " 4'2
If A DATE a -e21•• ,. r
PRIET> sr —r--e k'A dem/
Bulletin#100-January 29,2016 Page 1 of 2 1c\Handouts�Panmt �
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