Loading...
14-100693 IIP &VIM i{: - I S CAI EL % t • CITY OF PERMIT APPLICATION Federal Way FEB 1 2 2014 CITY OF FEDERAL WAY PERMIT NUMBER / y _ / 0 C4IS 11/ 9 3 - / P TARGET DATE C __J SITE ADDRESS / SUITE/UNIT# 320ci5 tactR c 14iskwes..( S PROJECT VALUATION ZONING ASSESSOR'S AX/PARCEL# L/1 1.(90 1 5- 00 .5- 0 - 0 I ( o TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT Ce1I_f',JI m,�1©� rnl ^ - Pkase 2 PROJECT DESCRIPTION Com�`Cne eXig-1-‘15 Vete sem/ er►4 xnkt one (4ctcirC556)1c. Detailed description of work to 1 ' . `• ► t 4 jcc'J° be included on this permit only OA n e L 4n TI n C C S 11C.{ r S Rite C. J Q �, cl y �' Q ��S'�(�(h3 fn e A r,� Me is Col nerl nPL pa JCc cnppt In extc1-1nc NAC cic hl NAME " PRIMARY PHONE` PROPERTY OWNER �-�a rsc \ :.Sl J It-ors MAILING ADDRESS �� � �L� E-MAIL ® CITY It`r IL 74 /� 1 tE ZIP OV NAME ahi./Si-On ("l l�c m s- PHONE g28 -3 .86 MAILING ADDRESS(� � l E-MAIL '_-1 ` CONTRACTOR / 2C)30 /AicI r \c )c,•/ S///r���n r� MA7(,i`11�A�.1�'1 0 Wd inc..Lip,.c0i CITY VC+�L(r:� t'C, STATE��`J$� /�\•//� ZIP 9C6(3/1 A 6(3/1 F t ( o. sG2_ r i y WA ST T/tel ENSE# AS1"1e.+�M 4D2yJ('� /2PIRATION DATE/O /1 /'c 'O VOERAL A Io)h2II C >.P. NAME PRIMARY PHONE 5L-Me ctS C,nnVicti-vr APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME IN PRIM.9gY PHONE PROJECT CONTACT GrIC Mc...1\w\w t t n € (2tGY- MAILING AD RESS E-MAIL (The individual to receive and S ` respond to all correspondence 'd A c r� q"t,y See a Jpve_ concerning this application) CITY / I,1 STATE ZIP^ I`'-f FAX NAME ``'1J`n-Vn°jbl� Wil- (",' S 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. 7�`, r SIGNATURE: �� �/2M. DATE 2.'/2-201 s PRINT NAME: 1 4(/c / A 6-Tl w i iN Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Pernut Application