15-100349 IT�PPL ION
curt OF��.. PERM ��
Federal Way
_ JAN 2 3 2015
PERMIT NUMBER I 5 - ( 0 0 319 - fi1E CITY OF FEDERAL WAY
_ TARGET DATE cos
SITE ADDRESS t 1\ Q� g 00 3 SUITE/UNIT#
3 a 2)o CA\cln,a nkcd P(LU) s 'e� orod 0301
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ %6 S 00. 00 e cic a 1 c( a b 0 - v S -1 0
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT SpV*4-41 Sbv(\V \`eo� (O(\a-( at(ilk c
1tc\ -t-0,1t PTV aptc) IR t C----0C - (.0 (A-c---101U VC.
PROJECT DESCRIPTION
S o S S� —
o�, s i l( . �IG�rs
Detailed description o work to ��L�S a�
.f
be included on this permit only t U S'^ 4 tr c ci-e_tr4-1 .
NAME PRIMARY PHONE■
P R O P E R T Y OWNER t(k'Uc k.0 CAN,k.� ti-Cr. S 4 6 s 1-
gao Saint) P of -k l0 1\� EMAIL
CITY S t oat I. STATE TZAO S
NAMIAk 66\ c �sc.oct 5 cLas) 4q.3 -13 VS
MAILING ADDRESS E-MAIL
CONTRACTOR O a`k O ^ S� 5
CITY O Sw et ZIP^ A O FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
AuaRT1a.4 aoaCZk a OJ / tS k3 kbSSLC boo 00
NAME S`�CA330 U ( :1-f elt.i\o l e t tS -roc (3 b o)w a2P1-C2'3 b
MAILING APPLICANT a g ADDRESS J E `CB St-mptru-A i h i
��1 (1■0 r�CL. tZ-0 GL d t
CI
woo ATE ZIP(A%aa a (,360 L - 3S b0 °m
NAME T PRIMARY HONE
PROJECT CONTACT �j t�C O(((AS \ f..1-6 0 t0 C, -NC- C1b6) 10'2,01-C236
(The individual to receive and MAILING ADDRESS C2-0 J ^ErMrA-IL 1.`
respond.to all correspondence Z n \o�r CA.n �'`` 4�®S` �� � r�m
concerning this application) cl ���o O 1 STATE w� ZIP Z'CI a C3 bo)6a°1_3 5 b 0 os
PROJECT FINANCING N S ta."4 l.0 UN\ trCAN'S tktoc?k+—et ,OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CIV,STATE,ZIP seams I e.. w, PHONE
(RCW 19.27.095) 4%66 C ous\,.\ P b t r i- \a i Y1 /' a[!1 o S
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 ciai,. a j� s out of the_I" — of the city, including its officers and employees, upon the accuracy of the
information supplied - -. as •pa ie pplication.
SIGNATURE: 7 M /y 1( �I `\\ '/ (� 1�' DATE
1I 1 \S
PRINT NAME: \�L 0,-k &- . t' tD 11Lr film d S
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application