No preview available
HomeMy WebLinkAbout15-102446 an,oFA PERMIT APPLRN Federal Way MAY 21.2015 4- 11 (0 _ 00 CITY OF FEDERAL WAY PERMIT NUMBER I 5 _ I 0 CDS TARGET DATE SITE ADDRESS SUITE/UNIT 4? 6.7 91 ►a Til-cif/c, //W/ - 0(47-1-/' '6--;c4-.-e.41___ IA)47, (AM- PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 3Sioo0c7 () rim- L' o 7 2 0 y 1 0 - 0 1 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING lI FIRE PREVENTION NAME OF PROJECT CKtST 0_60 8Ls c C PROJECT DESCRIPTION NE0 Fte� cf -t � Srri'i QFt A1 - FQ/ 6 Detailed description of work to ED L'- 1,7t E.a I LOW El be included on this permit only �)j ...__ NAME . PRIMARY PHONE U1 PROPERTY OWNER (iR_os-i 'L) (,J 'C PA-eTivgP-3 LP ZOC -ZIP 9c9'j' MAILING ADDRESS E-MAIL 17766 .s 141,01Pa P1 'AL .02.- CITYat at 6 STA ZIPq f/'-f f NArive&-L MGKg .' CoA, 1 F-u(tio�ME PHONE .__ MAILING ADDRESS E-MAIL CONTRACTOR /77A Pe . Ill©nv 6S //rlJ�ein/7e1 At_ DP, CITY STAT ZIP FAX BRe1 eu �- of/iii WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / „ ._ NAMEePA*12-10-r hE€ Pizo I �c ,oA, PRIMARYPHONE—0-6-,2110-, 0 APPLICANT MAILING ADDRESS _ E-MAIL 2"10 7 70-r1-1 l.;s CITY STATE ZIP FAX -172-CO 01 it k?k cavil NAME PROJECT CONTACT POIY1 A-0 ft i'at21)l eft PRIMARY` PHONE a " Au/ - L 4 f-3 (The individual to receive and MAILING ADDRESS ME E-MAIL ft,to all correspondence A7 01 70 . & &ft,all S epa_fir OT i'tea.cop-I concerning this application) CITY STA ZIP FAX ATA_ NAME OWNER-FINANCED PROJECT FINANCING El 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 cit a part of this application. AT /r SIGNATURE: DATE `�/ 3 PRINT NAME: RfoleAf $iZkHoViGN Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application