15-100280 REAPED
i
CITY OF JAN 20 2015PERMIT APPLICATION
Federal Way
CITY OF FEDERAL WAY
CDS
PERMIT NUMBER I S _ / Q 0 — E/ TARGET DATE
SITE ADDRESS SUITE/UNIT#
31-11128 PKAF'\C. Nwy S. F6oE wPa , wP cl ggb3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ NO• gb ikeTP11 c. 8 b ci 0 0 - 0 0 1 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING ®'FIRE PREVENTION
NAME OF PROJECT AQUA A- QUA
PROJECT DESCRIPTION I r>St a-tkk�'vr� o con v mak'bre 4-' ort -fire n.a 1
Detailed description of work to re, 'Wee e.X%SP r .par •
be included on this permit only +�
NAMEpp�!'' /� PRIMARY PHONE
A
PROPERTY OWNER QV/T Qu ,c> ("las) 26,9-- 223
MAILING ADDRESS •� -MAIL
`730 Sw 31-1 Tv Si-.
CITY STATE ZIP
(Zent-Dr\ wp. 'J WS--4
NAME PHONE
YVQSK rlaorr Alam, Inc . , (Zo 32$ -3288
MAILING ADDRESS � �1E-MAIL /�
CONTRACTOR 2030 R11Q SPO W'p'-1 i LOIW�U� Com' tia",•4
CITY STATE ZIP FAX
Sea-kf.t WR 9t1 -ay (200 322-7244-1
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
WASHZA't 2'2C3 i2 / OS /15 2O-CaO -1°1029-00- Si.
NAME, PRIMARY PHONE
{--x-110. 1-cJ1vrl (2010 328- 3285
APPLICANT MAILING ADs � \{r,«AE-MAI,a 1-�L
� ,A� n►
20 30 A-1a.-c oax Wray rgi aia��h..
CITY STATE ZIP FAX
8 ecot1.e WA Q 81 39 0)32-2-721 y
NAME PRIMARY PHONE
PROJECT CONTACT H1Iar6 t (200)328- 32$%
(The individual to receive and MAILING ADDRESS EMAIL1 �� �m
respond to all correspondence 203o it-IpLPog-i 'W prki S. 11t,auwiunP WA co0-1
concerning this application) CITY STATE ZIP FAX
6eck+fke WA gSsl3L-4 (20o)328-3Z88
NAME
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 apart of this application. y
SIGNATURE: 1 `Tj DATE 1) ' �' 15
PRINT NAME: 11`a�J1 taw 1-Vr
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application