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14-105897
• •,, S CITY OF i' 41/4' PERMIT APPIEI ,riATION Federal Way NOV 12 2014 crpPERMIT NUMBER 14 _ f CITY OF FEDERAL WAY TARGET DATE CDS SITE ADDRESS SUUITE//UNIT# PROJECT VALUATION ZONING I_ST AS SSO 'S TAX/PARCEL# D C) lzoo- q `� G6- 0 y - n r TYPE OF PERMIT ❑ BUILDING E PLUMBING ❑ MECHANICAL E DEMOLITION ❑ ENGINEERING IRE PREVENTION NAME OF PROJECT ( 7 M(P_ PROJECT DESCRIPTION �,h � 1WIrCOO A`v fJf t\kF�'�(irnis�rdEe5 C d I r s Detailed description of work to w U be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER COMA A ��Ak-Met4- rA fr/ ��( MAILI DC) ' 1 L �`"\Ip I��,�Y e E-MAIL CITY ‘vi STATE ZIP {v NAME \ ((��I,`IG 1V\ L: I ex M IOC . 1st ,326- 3Z -32 MAILING AA`�IIR(`'►E�SJS f E-MAIL ,� �� (,, CONTRACTOR �/�© ArFO Wel I7�I1rAla�AIA liII f\Ci6miteq CITY /� Q fad ` @ -�TE ZIP C16 �r•� F '32z. 72'Li WA TA CO T. EK'S Fi 1`JI �E Ol l WAYIBoUSI�SS LICENSE NAME k (n� r'lmv PRIMARY�LrrPHONE /�(JI 1"WWYI "_^7i^•_f__M�-D� CtS C_F)rc�c2•C�e)f APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME PY PROJECT CONTACT I�'ILw. M�`(i(,-1� 2O6PHONE -3 -3295 (The individual to receive and MAILING ADDRESS E-MAIL . �` 'L /r respond to all correspondence 3:58 Alt" �\K.� mn,c�l UXIn® 565)•h G vim" concerning this application) CITYSeake ATE ZIP s134 FAI _ - A - z6 `�(wWA (q` �1J�Vryv S c0( NAME PROJECT FINANCING 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 theproperty 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 to the city as a part of�thisjapplication. '^' SIGNATURE: 11A� G,�-_� /�—i/ Ct'? DATE //' 12- 20 Li PRINT NAME: YV IC.rt "ft C t r ity Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Perrnit Application