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13-101111 � ( - 1 ° ( 11 \ are OF '.-'' *PERMIT WMF CO ME PL DE EN P Federal Way COMMUNITY DEVELOPMENT SERVICES APPLICATION RECEIVED 253-835-2607.FAX 253 835-2609 + !%'.:c�y�r(�e•a;! r i r.,�.r;.. MAR 08 2013 '7b SITE ADDRESS CPPN'EJP FEDERAL WAY 12-ti.'7 S W Dash ?o i 4- {' ci cos PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL It $ �2.1000 ,00 l 2 Z I D 3 - CJ S Z TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 111 MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) Way s ( el.& C hl,(,v►f-(-1 PROJECT DESCRIPTION Ihs Tom.`t a��'0 w to-l--I G 1��o i1 e-r(tJC,L( V.'s T-sI 1 y2.4, F6 P�T- Detailed description of work to I.0 1 (NG ter S" cl r t a.14s'n-I I rs ys�► (exc ee-I- Hort,Vs-h�lle be included on this permit only GLW•CKI f ) rj-Srer^ Pr'ttGtLGt-d drA.a I IL 9 S ~ NAME `J ^ PRIMARY PHONE PROPERTY OWNER (A)a-(( S Z ck C o✓\ Q r 1 et- ov.f,' (kL.4 MAILING ADDRESS ,,J E-MAIL�. 312-4{'7 -5 w -04S 11 l -4.• d CITY e. STATE ZIP D Z3 NAME PHONE Meldim S,rr:ur;f2- rclec-4 C zr3 co32r- 1-Z MAILING DRESS E-MAIL D i3'D y 71 cote/vieerW4 tcu r/ .bs CONTRACTOR � r � 5 '� CITY U' ` Z(-P�•'•-' 780 't2 FAX 6,30 0314, WA STATE CONT CTOR'S LICENSE It EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE It IYl e N c 61 S-c a- 5 /13 // 2 v-04,-too t s-r-o o -19L NAME 5^, �S a 6 0 u-r€ ^ PHONE APPLICANT MAILING ADDRESS (`r� E-MAIL CITY STATE ZIP FAX PROJECT CONTACT NAME PHONE (The individual to receive and 5CO H a-c~•/ S 5 a"-A. Q`s bo se respond to all correspondence MAILING ADDRESS n a E-MAIL concerning this application) st-otfemev-1 C�1 ctose.0-LI V"I ,62,.�" " CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL - PROJECT FINANCING NAME�(/ D OWNER-FINANCED Required value of$5,000 or more / (RCW 19.270951 MAILING DRESS,CITY,STATE,ZIP PHONE I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses,and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person,including the undersigned,and filed against the city, but only where such claim arises out of the reliance of th y f f e city, including its officers and employees, upon the accuracy of the information supplied to the city as a p of this application. SIGNATURE: 4 DATE 3—$-/ PRINT NAME: Flo o T!a Ot-fe-/S Bulletin#100-January 1,2011 Page 1 of 3 k:\1-Iandouts\Permit Application