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14-105000 6- , e PERMITINPPLICATION Federal Way 9 2014 U Y OF FEDERAL WAY ----"'.-.....''s...*-s'a PERMIT NUMBER_IY_ I U-. D n O - FP TARGET DATE SITE ADDRESS SUITE/UNIT# "*5W14 1a211d Al..`(r- S PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# ty I C�(Q I 2 1 5 �{ `b 0 - a O z- 0 TYPE OF PERMIT ❑ BUILDING PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT i� •lases icAr & Jei rx PROJECT DESCRIPTION r—ii - - - -_ Detailed description of work to a i,,,, J` a'J ,►11 be included on this permit only p ..., liact)t!w.f`iQr«1q, Df'R �i;c e g i!\S' 14 l�ew ©Xc{q�r'f, C4(N" 4 a & 0gtiger, riip;v19,--t- NAME '- NAME PRIMARY PHONE PROPERTY OWNER 'p)'Ad- � 0)04'- Pr +i 26-5- 34-1-i(ej MAILING ADDRESS caz-3c-r&"` �,�': tMAIL M1- ndV& Act ,�i-, ett E 1 PHONE > P I0>~+h, �.- N 4-(A/ , to c 7-.�`i-S3 i-`3411 Li MAILIN S CONTRACTOR tot-G (14h - 1✓� 5�� i n L6-- if)UM . CITYFAX `�E3teales,P- 65Th tkc.4 4 --tS3-S -©3 _ ion WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# TACO w1P_N2-7I 12. to , 3i / (y N C6 I e- PRIMARY`S PHONE 49ii �LINGM►DDRESS E-MAIL APPLICANT k53)7tltt' S-fr e, 5��r, GI bry wepio"117 4, TAE ZI FAX Cdeli 7E /`,,, PRIMARY PHONE PROJECT CONTACT atm� `--O )e 2I - 49 , (The individual to receive and MAILING DRESS3 t y 9-t-, �' E-MAIL M�� �2 , `.p Le respond to all correspondence �' �� ���+ `F iUt1.�T�►+it�/ t concerning this application) �rt� �SZ5-3- Al � eL�w� WE� �-(L( Z53^ 53'7-0 3 S2-- PROJECT FINANCING NAME e....600_, OWNER-FINANCED Required value of$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 this application. SIGNATURE: �' jiCZA-N- DATE 2,0 PRINT NAME: 4) (t•(C.-".- CD ' Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application