13-103839 L
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• _ _ JOS & C'
RECEIVED 3
Federai way PERMITsokatif 6EFie +- u -
COMMUNITY
Y o�aPMENTA3 0 20 3APPLICATION Approved
2 FAX os
WWW.cii wI teaeralia •.r,,,n " As Detailed
CM'OF FEDERAL WAY J Subject to tached details
CDS
SITE ADDRESS 3y SUITE/UNIT#
314731 N-toEi(..N' '/ ' ''T ,)ate �( 'k"(
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ �D, C�� ? / o 4i - 9 r 8 6
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING IDMECHANICAL
❑ DEMOLITION ❑ ENGINEERING K FIRE PREVENTION
NAME OF PROJECT b
(Tenant Name/Homeowner Last Name) C�ointxJ1 1T )E TRu. FE) AL- 1J11P1'/
PROJECT DESCRIPTION MUDA` I 11AL lsTlci- S'PR11�It ,IZ 5%TE TO
Detailed description of work to Pi 03b CV .-c'1/4W.,_ U.>t/UPLL51 (,Ju AJ(j>
be included on this permit only
PROPERTY OWNER NAME \(y \�1 PRIMARY PHONE r z
MAILING ADDRESS
1t.4 Q V1FTK c\& , STE- ' CA ./.rri clecgxnet..conA
CITY STATE ZIP
NAME PHONE..
tNC\,fi1% FVZZ S/STEIN X53-Z 3 a-t'8
MAILING ADDRESS E-MAIL
CONTRACTOR \\O V . -1-)41'N Of_ SPIT- ,,¢.ZA M 4 € r r�4n
CITY STATE ZIP FAX
T C"cc`t`c Uva q .. 5' -'qa1.-- a' ;*J
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
.Mc1115 \WD 3T 1a / 3i / 13 5- D D-.1 L_
NAME PHONE
�s.",'TN ' ifit-'SYSTYx(15 -253-,az-a- 3.7
MAILING ADDRESS
cm 4-1' A ''VE. )cr E-MAILC`�
APPLICANTi (# se` moi,,/
CITY STATE ZIP FAX
-. M P'% U.fl - e ik D1-1 -q3(.- 35-(7
PROJECT CONTACT NAME
C C ^AIj C PHONE
(The individual to receive and rG� :2j3- r` w- min
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) t\C) g`54 W AVE. \ Je 1{SM iD S,,,r Af'i rZ.t 't
'h
CITY STATE ZIP FAX
` PC(O 1A WA il'1 s3'"-SaC.-x350
ALTS ATE CONTACT NAME: PHONE E-MAIL
,f KK l tl (Z!V __ X5'31-I A %- it v rfke ,�
1''�,,u ll{la.cot,
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required value of$5.000 or more
IRCW 19.27.0951 MAILING ADDRESS,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 the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application. r
SIGNATURE: t DATE _g,a5-13
PRINT NAME: -ArF 5fiti -/
Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application