14-102124 1111
Federal
PERMIIAPPLICATION
Federal Way RBCEVED
PERMIT NUMBER
14- oZ ( MAY 082014
� _
- - TARGET DATE CITY OF FEDERAL WAY
SITE ADDRESS SUITE/{Ij3S
3 4/001 PigciPg. Nt)i SOI,—/a
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
L oOO 2 , 0 y _ 9 ,0/ s
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ENGINEERING L'S FIRE PREVENTION
NAME OF PROJECT
PLOCaZG,s,S ItJf✓ f iJS'(J2ANCC
PROJECT DESCRIPTION TpLi- /J(_LJ WET i# A? ' SYSTCitA THe0cIC)HOur c Arr,2E
Detailed description of work to SUILDIA-1
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER YeoGecSSIvG G JUv1.Suk
MAILING ADDRESS E-MAIL
34
O(l PAC F I .- f-I lam/ .
CITY STATE ZIP
A Ci :Co3
NAME PHONE
A ir.c=-I r° ';�.;tir�T12�Ic.,7 l;;E. ( I A.(C- 2.53• t2)1 Z- 1111-
MAILING
1222MAILING ADDRESS E-MAIL PDEL((IQ 0 O e
CONTRACTOR ess Z_OU h cST R.-c- E 7 Pecl-lr;I:.CC#JJ U/CTlan/.
CITY STATE ZIP FAX
�CEtil i t,JA c8d32 253 el2.•12-1
WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
f-CHCT 4,•LtctDe_ y / /
NAME PRIMARY PHONE
4�c Tc¢.. "Der LACED Z,5 'z-122?
APPLICANT MAILING ADDRESS E-MAIL
SEG cotil-r?, cTb/-
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT t�=2 DG f D 0
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence S 6.e C.01,-1-117-A LT n R
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ 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 arty 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. /��✓� j
SIGNATURE: DATE L,
PRINT NAME: ?67z'2iL DELL.?AD 0
Bulletin#100-January 1,2013 Page 1 of 3 k:AHandouts\Permit Application