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HomeMy WebLinkAbout15-104871 A �.artOF • PERMIT SPPLICATION Federal Way RECEIVED 7 i _ SEP 2 4 2015 PERMIT NUMBER '� ( a — — - - TARGET DATE CITY OF FEDERAL WAY CDS SITE AD DRESS SUITE/UNIT# 35 82.0 \j FJHAuS .,n. Guru / s PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# 6 , 914- z t c 4 G t - 0 0 4 0 TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING .11 FIRE PREVENTION NAME OF PROJECT ? M 11J e i...‘Ce ilg14f%Tk+ PLAN) O CES PROJECT DESCRIPTION kpo it a.,.. - S1'R lr,-L-5 l�' 0`' 1 L)ALLS 4 Detailed description of work to C.,.�ti..-t be included on this permit only NAME ..__... _ _ - __. -. ... ._ ~PRIMARY PHONE PROPERTY OWNER )nil Ve14ToLES- -e.0�e4.... k `L-C MAILING ADDRESS E-MAIL (i L'4 d l(ole 1-1G .tt I,t`30 CITY STATE ZIP r NAME PHONE _ u Revue.. `--T-caxsTl tl--i Z`53-- t'7 a-Z 2-V7- MAILING - 7- MAILING ADDRESS E-MAIL CONTRACTOR 18S-5.- S 2-c( 1"- S'[' A,S21R�-er e A. d,Ij,1t.c7l-jSrEar-iyw-1 CITY STATE ZIP FAX `''' e JT WA- (ieo A 2- Z-53--01z- 17-'1/ WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# ia,P.CVt-G1 tZ- / 3t / i 5 NAMEPRIMARY PHONE c)c(TC se Ige-el- Zs-3-Eli z-- i zo-Z- APPLICANT MAILING ADDRESS E-MAIL 1 $s`S .$ 4&,)14.. ' ST - Ig.Tiiz,r a c , at„.-‘QTc- CITY STATE ZIP FAX 1 Kz�T Cf1- x•'..31- 753--a-7Z- 7 Z-71 ^ NAME - _-_ _ PRIMARY PHONE C PROJECT CONTACT 5i&-r✓ e- (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX - NAME .- . . . PROJECT FINANCING 14/i4.. 0 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 city as a pa • s a••lication. SIGNATURE: s.' DATE 1 - Z 4- I-S .--_________:PRINT NAME: - f:CT Se t P,es-ru— Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Applica