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14-102034
• RECEIVED • MAY 0 6 201PERMIT APPLICATION CITY OF iiiti Federal Way CITY OF FEDERAL WAY / / CDS / y PERMIT NUMBER _ / 0 2 03 7 _ F �[ ( (/ ✓✓✓ TARGET DATE SITE ADDRESS SUITE/UNIT# q 5 a SW Cou-N Rpu5 R. C de.ac u\1 LO-A q�S0)3 :`b3 VALUATION ZONING ASSESS PROJECT VAOR'S T /PARCEL# T/ 4qe l U _ ,' 0 (-( 7 TYPE OF PERMIT ❑BUILDING ❑PLUMBING ❑ MECHANICAL ❑DEMOLITION ❑ ENGINEERING PIIRE PREVENTION NAME OF PROJECT Glen-1 cur 14_/0 q ) + C m pws PROJECT DESCRIPTION S� �p� `��,,� r� (-��y G P description of work to eto T F X1.1 1 a Pc L S 1` 1 SS P 6 R. ro'a(s, 63 be included on this permit only (� NAME ,,.. PRIMARY PHONE PROPERTY OWNER Cdi f-Vt'e 0 G tenRo-r . LL C.- Q53-S3S- loft) MAILING ADDRESS MAIL G Sa .S W ADDRESS .-.p ,15 R ic?i•azo Q -6,coin CITY in I STATE)A ZIP NAME %n%� t•R.k�1�-e rA ion , L LC'_ PHONE fl- ci.9 -3413 3 MAILING ADDRESS L E-MAIL CONTRACTOR 1nt X01 10f Afto. lE_ ) _ Ihrowninc)/dtnfintty- . •apcn CITY STATE ZIP FAX • P07) ILIA c1$36b (Ahn- Soto- Y1-.3 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# 1\)F- M QG• 1 QM 0,(51 /114 0- ID- loal13, W- BI-- PRIMARY PHONE NAME \TO- F,psi co*ee -ion LL- Y1-2,99-3413 APPLICANT MAILING ADDRES t� E-MAIL 1'1``lC 1 1 d - PS I 0. `-L � lbrouDr P t n-,rxiq-, toe-(fl,, an i,J Z 55 FAX b 34 93 AME r a,] P PHONE�j n� PROJECT CONTACT \ ZCQ�{\\ )oircc 1 P'�6. �- bcis-3�'i3 (The individual to receive and MAILING ADDRESS C *1-0(e, F MAII respond to all correspondence VT-10` 1© 4 SE � ont�P it tT1 nit -TI .cL ` concerning this application) Y nton rsoT�E 9 ZIP 5 r1-11(/0-34 NAME W rT' PROJECT FINANCING 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 ha niless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation and defe• e of such clot which may be made by any person,including the undersigned,and filed against the city, but only where such ci• m arises • of the reliance of the cite_ including its officers and employees, upon the accuracy of the information supplied t• the,ckt 1•. •• ------ SIGNATU• •��∎ DATE 5 PRINT NAME: 111 r 1 1 _■ Bulletin#100—January 1,2013 Page 1 of 3 k:\I-Iandouts\Per nit Application