18-106078 RECEIVED
n i� DEC2 q8 PERMIT APPLICATION
CITY OF ,- C 3 i 2018
Federal Way Clio OF FEDERAL WAY PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER 1 /f Q� _ 0 7 _ �^
V //�� �
— TARGET DATE
SITE ADDRESS SUITE/UNIT#
O s . 3.: i� 1?vii4.6- A
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ I/000 -
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT C e7Q p &L A z A
PROJECT DESCRIPTION & , fel A Cat R 0 0 7 „� hf lc
Detailed description of work to P [r , "� v
be included on this permit only
NAME .�,7� ' PRIMARY PHONE
PROPERTY OWNER fwCG 0.c-v PL f l �6 31/-2-y
Ps-
MAILING ADDRESS E-MAIL
/ tIV-L. PI ICE Mar,t- �wee. c/4 e-d;v-.
CITY / STATE ZIP
PHONE
NAVIE
UV”'g(ter- (/<P/L 5 t �
- -/V C . Z s 3 m-25 5-- /g21
ILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
M�,K.___ IM c- o(u../\--- 5-e— 4-is
APPLICANT MAILING ADDRESS/ ' E-MAIL
/ Z
Cff flet
CITY STATE ZIP FAX
---137.-/Z6-- w 98 '22
NAME \\ PRIMARY PHONE
PROJECT CONTACT /774/L //IC ,L o& 4'L/)
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME t',�`!'`
4 Q 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 Iaws.
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, include undersigned, and filed against the city,
but only where such claim arises ut of the retia ce o_the city, including its oilers d employees, upon the accuracy of the
information supplied to-ttIe city a part of t/ti •n. ,'
SIGNATURE: / DATE .3/—/63
t
PRINT NAME: yl< //e-60 14" -i
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application