20-101064 ....A, RECEIVED PERMIT APPLICATION
CITY OF
Federal Way MAR 0 9 21::: PERMIT CENTER+33325 8,h Avenue South +Federal Way,WA 98003-6325
253-835-2607 +FAX 253-835-2609 +permitcenterrcityoffederalway.com
COMMUNr Y DEVELOPMENT
PERMIT NUMBER - 0 Of 012 4:513.1) (,■/ _ F /// ,
TARGET DATE
SITE ADDRESS SUITE/UNIT#
13 LP S. 32Ss11"' Si-re-e-1-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 500 00 1 4 } 3 I _ 0 0 1 0
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT Celebration V\1 est Senor giving
Inst at I er -S radio -1u rrsoni-t-or -ex is-h-y,o3---
PROJECT DESCRIPTION
Detailed description of work toC?-
be included on this permit only
NAME M ebr a S.-MY Li vi n g PRIMAR2.53'PHONE a31_.5026
PROPERTY OWNER MAILING ADDRESS E-MAIL
1�1 l e S 32 '' SA-
--,
CITY \VVV/wv
bra I Wo�� STATE„41- ZIPct00
NAME ' . - PHONE
Ci varA y a h S ecl vi ty S y c rYI S -zo(0-1022_—LoS ti 5
MAILING ADDRESS I�`I,J� 'st E-MAIL
CONTRACTOR //h1�`�!
CITY eQ' 1 W STATE ZIP FAX
WiCk. q 31 L1
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
but9.12--Q SS 23'3 Y-S 0 / 30 i 20
NAME S��1 I%h � PRIMARY PHONE
200- (.o22-fM2-1 S eXi'211
APPLICANT MAILING ADDRESS E-MAIL
ISL 7 1..5_ ve S efisheAe&gvufdiaYVC0k/ nt"fli
CITY - Ac L STATE ZIP GI s,13 ' 1 FAX
NAME c �+� ,V,lv/VTTl L}I PRIMARY PHONE
PROJECT CONTACT S •
Ck(Y�e OIs c pl‘cant
(The individual to receive and MAILING ADDRESS ` 1 E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
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 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 supnpliiedd to the city
as a part of this application. (, /J/J
II
SIGNATURE:(T/V"((IPA'"v ' DATE I `�1 !N
PRINT NAME: a(6 6I ►y l 1 /
Bulletin#100-January 29,2016 Page 1 of 2 k:AHandouts\Permit Application