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13-101696 ,0 0 1110 CITY OF PERMIT APPLICATION Federal Way App pvEDD RECEIVED 31y43 PERMIT NUMBER ( - 1 0 ( !// ' l ( - Od APR 18 2013 YYYY!!!! TARGET DATE dry OF FEDERAL WAY SITE ADDRESS SUITE/UNQ®S ' 1(90G PCta W{5 wil S- 131A PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ cOD i I q_ - A_ L TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑�MjECHANICAL CI DEMOLITION 0 ENGINEERING X FIRE PREVENTION NAME OF PROJECT PC Vl \C b11 S r- 1 6IcE PROJECT DESCRIPTION L S�c.((. P L.S cc , k-rr./,S(vt(l4Q r Detailed description of work to be included on this permit only NAME / 1 PRIMARY PHONE PROPERTY OWNER Lccs f 1„ R PA i�QMAIL ✓} DDD- SW,99)$' / E-MAIL •O� CITY �A_ STATE ZI�/y� O 1%�+/YY/��' '' NE NAME Vc� 0 e A acnr• _..-C C hFhOb- '3 - `? MAILING DRESS+l J� ( E CONTRACTOR ©�/ A .<c �I(`' YnMCI C�Glit t11�f C,f�f1>t ON CITY TAT ZIP FAX SC?c-��Q- a C(9. 134XL'33- rk I ( WA r} 1 �- Al C 1, A o N [3 r LICENSE NAME W�L��I � ^ A W_c /►II T`" ,'l 1Wli ik PRIMARY[I)h PHONE - t V APPLICANT MAILING A�p_Iz s_ �,r pG`� \ '4` G t E-MAIL //��� mm et t(IlY{i'n bN "�S ILII L/r(1�� CITY %(J{/ei/``4,,4-Il t �Cc`IAdA ZIP LV t 11 �4 F°V r7 NAME wade( /� -� Q' PROJECT CONTACT I V l C Loop F 1; 8` �g ' (The individual to receive and MAILING DRESSY EMAIL 1_ respond to all correspondence sO 3V ,A1 Ca Mrv:1�G1Ll tIC1 ASMelyrnt01^ concerning this application) CITY G I n VIA ZIrtS 1 FAX f {� NAME C �1 PROJECT FINANCING 0 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 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. ') 74 SIGNATURE: l- DATE `7 �� .243 PRINT NAME: ) . /\')'- /\i -1 / r ' / Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Pelmit Application