Loading...
20-100764 ___A, RECEIVED CITY OF FEB 21 2020 PERMIT APPLICATION Federal Way CITY OF FEDERAL WAY PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607 +FAX 253-835-2609+peiinitcenter©cityoffederalway.com COMMUNITYh DEVELOPMENT PERMIT NUMBER a O _ '� 0 0/ 1 (I/ _ F- p toi Ps- TARGET DATE SITE ADDRESS SUITE/UNIT# WO ,R3YC\ k .L. �1.-t a -c \ Wa.tJ� i \i aWg3 PROJECT VALUATION ZONING ASSESSOR TAX/PARCEL# $ �_/ko0 Lj3 04c C.A.L\ ' " .-- (3‘ ^ l D Lk c1 I (9i 7 TYPE OF PERMIT 0 BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING WIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION3 Detailed description of work to • be included on this permit only •— ' NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS B- L 3\a0� i -kik .5, �STATE ZIP j� V1CC)Y \ 14b(CA v1 \ W\ qAMcornQOI- 1VILuC CCVC v1 CUr\ hyj n17 ( 069 (J - 3g/1-U . MAILING ADDRESS� AIL CONTRACTOR \ 1'3 \"`k AY�C,ITY _ �G�'`i gi���� FAX WA STATE CONTRACTOR'S LICENSE# qPIRAE1 DATE in.viaBUS1NESS LICENSE# NAME RIMARY PHONE r- i'R, -CAC' ,akv\,DV` VD"\GT t Q1S - (Z14.{9 L G ADD 8 AIL APPLICANT- V* A;i e-6 rqL�,�V\0(� • FAX ACV NAME \ •-t •YPHONE 7 PROJECT CONTACT ,Qbk`(e'Q rr��,t�c�v . /Ci)(1 - 'J D (The individual to receive and `MAILING ADQRE88• V MAIL �respond to all correspondence \k \' -16NP_ 6 6votcp ao v concerning this application) sink1 r) ST ZIP FAX u \i Pc- 02121'1 uo1/41(cktoovikax vky..to 0 NAME PROJECT FINANCING 0 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 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 t. " e city as apart of this application. t (/ 04 SIGNATURE: 1 ' ,� t DATE 1 1 g I -) PRINT NAME: r Vis% I ' i \C\IA Bulletin#100—January 29,2016 Page 1 of 2 k:\Flandouts\Permit Application