14-104449 CITY OF PERMIT APPLICATION
Federal Way RECEIVED
PERMIT NUMBER I -
— 1 v - AUG 2 9 2014
r-E) TARGET DATE
,QTY OF FEDERALnnCCWAY
SITE ADDRESS SUIT)EBIQ! #
CC
PROJECT UATION� -�c�...n ec,� Part SONING ASSESS /P 01,11�fl�(� C & i L y g o 0 5
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING ISCFIRE PREVENTION
NAME OF PROJECT Bus' }i k 5 MCc Ce Fc,c1 ' ` 'o iii
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PROJECT DESCRIPTION �J'C Q I t CG tl\\V� "t o�V�\ �� Ct U II OYI F� 'CC
Detailed description of work to 9re-C,5t 011 S-te(V/ 4o OL2CO � cnt5
be included on this permit only Il
NAME PRIMARY PHONE
PROPERTY OWNER C4V)L, c,U 3 L6 C\f V\ 's Lp
MAILING ADDRESS E-MAIL
10t5C, 4V LP sr St E -100
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6�,kn`,' `Q kST�AA ZIP c
NAME `\ k, V‘CO mck °kick. GERAP.S PHONE b TCL-1-10
MAILING ADDRESS�� -7 ' Roe.a C� E-MAIL
CONTRACTOR C O( ✓
CITY` ^q U STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAMEe n, -1 v� - owl
P YPHONE26 op; L-
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APPLICANT MA[ �+D,,D`� t E-MAIL
lW 62}� P1/4U� s
CITY t.`4lQ, ZIP
W Ci. Lo F �°.�, 761 _?GC
NAME ( i
`� PRIMARY PHONE
PROJECT CONTACT is ,on e. b` / !_ _-12 octt
(The individual to receive and MAILINQ A`DDrRESSSS t�n vi
E Ue l /jl�h /_1�11'� `�
respond to all correspondence `-' l l)V k AVC. S �X J 11 II.VI Y l 1 { D.
concerning this application) CITY ATE zIP ,may �,�\M
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE f
(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 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 t ity as a part o I. application.
SIGNATURE: V'� A.k. O -DATE 2 ` - /d__PRINT NAME: Z. C-10.-\A'1/1-NO 5‘...-4 t 'HA
Bulletin#100-January 1,2013 Page 1 of 3 k:AHandouts\Permit Application