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21-101489-MF-Building Permit Application-04-19-2021-V1
CITY OF 4AN Federal Way PERMIT NUMBER _ SITE ADDRESS 2- t 3Lq z� PROJECT VALUATION TYPE OF PERMIT NAME OF PROJECT PROJECT DESCRIPTION Detailed description of work to be included on this permit only PROPERTY OWNER CONTRACTOR APPLICANT PROJECT CONTACT (The individual to receive and respond to all correspondence concerning this application) PROJECT FINANCING When value es $5, 000 or more (RCW 19.27,095) PERMIT APPLICATION PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325 253-835-2607 + PAX 253-835-2609 + permitcelttera;Cityoffederalway.com TARGET DATE SUITE/UNIT M 1. A14e S �-Cr M LUG Wn 1 111 ZONING ASSESSOR'S TAX/PARCEL k BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION © ENGINEERING ❑ FIRE PREVENTION 7. tn1 EG , T 'N CAi i -rF Cl fis rvu 1"cea NAME 40At 6 C%MN-rV MUSMIG A rkoc4 PRIMARY PHONE aQ, - S -7 - r MAIF,ING ADDRESS t�� E-MAIL orTx isr' n A z WI SPA f NAME PHONE MAILING ADDRESS ISSA Cam C IF -MALL +l ! r u736,7 CITY NWA Bw �} ZI�b 2,-7 Z FAX, `� a" STATE CGNTRACTOR�LICENSE 0 EXPIRATION DATE UBI* NAME kiq PRIMARY PHONE MAILING -A7DDRESS � „/� � F MAILL � J� )33 C�N'D STATE�I\ Z I C% G FAX A I NAME PRIMARY PHONE HZS�32Q- -3/y MAILING AD RESS 13 �u CA r7 J [' (Nr'1/ E-MAIL ^ C C�1 CITY L� FAX NAME ❑ OWNER -FINANCED MAILING ADDRESS, CITY, STATE, ZIP PHONE 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 claimj, 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 t r ty as a part of this application. SIGNATURE: PRINT NAME: f 7C•t N��,�,ga`VEni 11 Bulletin #100 — February 19, 2020 Page 1 of 2 k:\HandoutslPermit Application