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13-105273 CITY Or Afp3017ED PERMIIA PPLIS N Federal Wa i� .;tl NOV 2 5 2013 PERMIT NUMBER 1 ✓_ - - CITY OF FEDERAL WAY TARGET DATE CDS of SITE ADDRESS SUITE/UNIT# q S-2- Sw C-c.w% 0t.2s O t - PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ '-1/4.00 , vo • `1, 2-- . \ 0 - q a ` l -'�- TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT Co k evx Pav u ti..D.cs. k-- CcorA p 0% kv.c\-.oM isc. --s -Vtve cklavvvi teamo ceVMVvLAA i c. J-ov PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER YJCSIA'vkle, Sa Pia © 2.53 cNS2 t,CA74 MAILING ADDRESS E-MAIL cic2 Sw C�WOt,% Dv. ngo,q1 MOO _v« .c1V4/1 CITY#t t..CA1 CjJ�v1 STATE A A.(27t7-3 NAME \�/.'°T k wk 'C the ' ve.AteLk-iov. PHONE 1- ". \ k-3/4472, MAILING ADDRESS \ t to N. ., S e 'A uo , C c eA wCN hi kt(- -I vA 1 t.o‘CONTRACTOR STATE ZIP FAX Q u " ki.91(k °tA c S-C' c61--1- Ito '4>`l-1-3 WA STATE CONTRACTOR'S LICENSE I' EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE Y t tQ 'its Pat- tavNA l2i 3 \ / i3 20 ko• 1t::,2-■13 . bo ,T)� NAME PRIMARY PHONE r '\t Pt S IV;o V E APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME VAC PRIMARY PHONE PROJECT CONTACT �� vv `��S P'v ( ;-;- 4b w 2>%-k--1--2, (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence p`W`� p`S P` ` eVeY11�� 4C iif� ZN\1°iiYe.Ceti concerning this application) CITY STATE ZIP FAX • PROJECT FINANCING NAME G■E',4/L \✓ek.vv_ oC ,-k- Ce&vvw0S s OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.27.095) CA"V-i S l.•-) l..sd,V•A P V s Dv . 2 Ste, at c'L to cA'1.1 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 Y/� 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 C. information supplied to he city as a art of this application. c\ I 1 SIGNATURE: 3 `"-- \.1.-- DATE 0- 1 o1D `\3 PRINT NAME: 3 �'�^ CAC \\t I Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application