Loading...
14-106031 CITY OF A. PERMIT' APPLIC � • Federal Way �^ NOV 2 0 2014 PERMIT NUMBER I4- SITE ( 0 V TARGET DATE CITY OF FEDERAL WAY 1 CDS SITE ADDRESS SUITE/UNIT# L L1 Nok . SC‘) PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# � Fj�jQ� © � � C2 Q - � � � Q TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 10 MECHANICAL DEMOLITION ❑ ENGINEERING CLPI PREVENTION NAME OF PROJECT i �� l!W I`e� ` `` W d�I. o C..C' l - (c�j` ifl;\ EC�dISnll.Tc�C'v PROJECT DESCRIPTION Detailed description of work to IG�i P C911�.(� �bni l(�, Cr" 1/1� q�f4.dam\sy8�M� be included on this permit only JJ NAME PRIMARY PHONE PROPERTY OWNER 'r� No•I e'it�f4:tp L Co G 1t k6s t.- . Qol Nc L1,itGAg} E-MAIL CIT)i'�1W SNATATE ZIP NAME 1 , PHONE kIGS�cnC1� Ate;eft�c. MAILIN DRESS V , E-MAIL CONTRACTOR 2 « C CIT_ a. 3 ZIP^w' -i FAX WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE /4A5I' TAI.2g2G3 l2- io5 s '210 pe-I d lb��- 00 L. NAME G� PRIMARY PHONE APPLICANT MAILING ADDRESS E-MAIL WA CITY STATE ZIP FAX RIMARY PROJECT CONTACT NAME **- ,_ 1\4.$4L. 111 PC/Ip PHONE0 32g� (The individual to receive and MAILING DREE3 A E MAI respond to all correspondence.7 /'�Ir(�k lYY',1 LIA iY1� '�h concerning this application) CITY 1 A:�� ZIP^�(.614 2` FAX �O/ "�2 z I L4 NAME Yv l•� X71..( le .�j PROJECT FINANCING OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW]9.27.095) 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 to the city as a partofthis application. • SIGNATURE: '��'�1f :���/�' DATE I�' 20 a/c( PRINT NAME: :VICV:2013 1•`C� Bulletin#100—January Page 1 of 3 k:\I-Iandouts\Permit Application