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12-102914 . A 0 ii.a - 20 _ ___/_L r t Federal Way PERMIT Itp ME PL DE E FP RE COMMUNITY DEVELOPMENT SERVICES AP P LI CAT I O N - - 253-835-26070 FAX 253-835-2609 2 5 2012 www.cityoffederalwau.com J U N CITY OF FEDFRAL WAY SITE ADDRESS CDS SUITE/UNIT# 3 2.9 2.,- l S i l4J eN LA e Sp ,,t-;- PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 139Z. Pc' 6 q 1 9 O © -` CJ 2. n TYPE OF PERMIT D BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING A+'IRE PREVENTION NAME OF PROJECT 1 �? (Tenant Name/Homeowner Last Name) Lt 1 ( `S ''t L&1' .� A iV 1) 1 +til. PROJECT DESCRIPTION L-Cid ,e& OC y .(.1i^1 K t C)D 2 �k/ G“& `G It c__ DetnilPd description of work to 'V�� "w 67 C 0 r(/Z.0 P SS 1C�i) '/"S1-& /--6 be included on this permit only to Q ,V Uf rrl w/J V) E-C l2 tAL 3o 0 Co ryli p 1-1 A rvir . 1"6".:,,, NAME PRIMARY PHONE PROPERTY OWNER . �00A q 10., i-}-J(Z,Y 4 SAN)b[LA MAILING ADDRESS E-MAIL it 303 5.e 7$1`` sr-. CITY STATE ZIP q ME/LC:EIZ, (5t-fes")- WA {g®-o NAME PHONE RT IA-00D AND PT)Gtcr Sc .vies (Kr_ Zc9()•7Zto ' oCi40 CONTRACTOR MAILI0OG ADDRESS2," Avc-NaG 'So E-MAIL nebllye rt'toocdtco CITY STATE ZIP FAX 5E ATri—e VAI A t1 k !OS' 20 b• 7b7 ZL 0 -1 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# R—t 000- ogsQL 12,/ i iZot3 NAME PHONE 42.-t- 400 APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX PROJECT CONTACT NAME PHONE (The individual to receive and ".)Ay 5' N G t3 C-71 ZO 6-174 -094 C) respond to all correspondence MAILING ADDRESS Tt E-MAILE�h C.b` C,r�hood.ca�"'" concerning this application) 4,l 0 0 l"2. A V 6. S h u�'1� ,,1° y CITY STATE ZIP FAX SCA-I'I- 1N 4- c1 g i 0 S 2b6.767' Zt90`7 ALTERNATE CONTACT NAME: PHONE E-MAIL R tcµAP ) Sv►'% (T—(4 206.1 *0440 (Iticir c) rl'4Gold.. Cc PROJECT FINANCING NAME ❑ OWNER-FINANCED Required value of$5,000 or more (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE 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. SIGNATURE: DATE t::• ( 2f2o12_- PRINT 2 NAME: Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application