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15-106208 ECEIVED CITY OF A lePERMIAPPLICATION Federal Way r,_Y 0 8 2015 CITY OE i-EDERAL WAY .1b1" IT NUMBER 5 _ 1 Q C!✓ Soo 5sF_ F Pc PERM - - TARGET DATE N SITE ADDRESS � �WMk:J/1E SUITE/UNIT# 333 10 P( i/ 0V . Violl PROJECT VALUATION ZONING ASSESS �!PARCEL# `F /000v`� 1 8 7.- 0 _ 5 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECT 40.11-"rc CA i �' PROJECT DESCRIPTION 443 /041e of Cl. ,fid 1.,/ .()A #74t,, T/ 1CM✓J Detailed description of work to eid") 8 8' "'fi s-Dit char r , (1 be included on this permit only NAME f) 1 T C ,4 F C PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL 3331 o Pa % Rc Hwy S Hoy( 'Fe.dc(cc\ tIJa STATE 41&Q63 NAME PHONE F10-el .4. S Poi N live Om "1f 5 ," 151 MAILING ADDRESS 14901. - ..., E-MAIL AT-Fs-14 C CONTRACTOR r '° / `T &��AA CITY ! . E? ZIP,7� AFAR /'41,PV ©l m ,fr9 15O3� 1/r X182- Va WA STAT CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE S A ev 1' omt , q / //lA NAME PRIMARY PHONE hi Vl ,` CV/e SG, '711-/ // APPLICANT MAILING ADD Otj� 141 "! 1 1thch S /A) E-MAIL ►��11' �� CITY � STA ZIP FAd�' el en17 eisag.fillicil- NAME PRIMARY PHONE PROJECT CONTACT (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX PROJECT FINANCING NAME 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 othe rev • the city, including its officers and employees, upon the accuracy of the information supplied to the city as a p• `of this applic• 7.n. SIGNATURE: A . A4 i I� / DATE /..2- -/-c-- v, PRINT NAM ' TO e 390/2 Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application