20-100858 111116.. RECEIVED
CITI FEB 2 7 2020
PERMIT APPLICATION
Federal WayPERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
WAY
Cr�,OF FEDERAL
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER
a o _ 1 0 0 g 5 c _ .- ? Pips-
TARGET DATE
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ pze,Ls-4606-Do esa_. . . q 1 0 (-( _ 1 OL( R
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ErFcRE PREVENTION
NAME OF PROJECT / 12C'1e21p-L ` 4,41 Ate% r L >Lo"2
01t ,u P e—2--- , /—a/sem) s. L
/ £ AI - T4. LC._ ��n1 e�2 pecr
PROJECT DESCRIPTION J
Detailed description of work to /CeJ,JC,�o/E(/ 5 Z , /3ec (4/d;.(1 Azad. S/c 7-e r"#/l
be included on this permit only
/._/')S div ),' ACE , F—
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
7S 7aL .5,4-7-0/r,-'Le i✓.Z".., a c/ 4 7 7 0141.1-e6121,yp 3 k6, -37"5--,o (9 o
MAILING ADDRESS n E-MAIL
CONTRACTOR 3/ 0 r2 k, '1,5(4 t-L 5,'I tie/2...d.e.-'1, /o Sulo/II LL:YIFrr
CITY STATE ZIP FAX • (but
57-6me r-i) ( - 9'g 3J2__
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE UBI#
.-T74/ s T mss/ v esz, 9 //sr z,l OO 97T
NAME /, PRIMARY PHONE
r(o# 1Y/ S1',///t4'12-A-14., L 9 , 9f -3z 7n
APPLICANT MAILING ADDRESS E-MAIL
3/0 o K L sc 1AY S • 0 s,'>le 'I, l' ;oc)/xffr�.goilo
CITY STATE ZIP FAX • cal .
dite'/,tu B.,.-J /4)9 9-g 3i-z-
NAME PRIMARY PHONE f
PROJECT CONTACT s5;4111e 4-5 -,4 4 o Li- �'� -g 14 ` 3 Z
(The individual to receive and MAIL;ADDRESS /r E-MAIL
respond to all correspondence 's e ,..i.S Ali pi.)L
concerning this application) CITY STATE ZIP FAX
II 4) f7
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When ualue 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 to the city as a part of is application.
SIGNATURE: d , DATE
PRINT NAME: oe' (/ S' /V C s2 4J,d r L.
Bulletin#100-February 19,2020 Page 1 of 2 k:AHandouts\Permit Application