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12-104268 CITY OF ,-. .. PERMIT SF MF CO ME PL DE E 'FP Federal WayRECEIVED COM1VIUNrf1'DEVELOPMENT SERVICES _ APPLICATION r-----.......s.„...„....„ 253-835-2607•FAX 253-835-2609 ww W.ciuioffederalwaii.com sFp 1 S 2012 SITE ADDRESS CITY OF FEDERAL WAY SUITE/UNIT# 2 g314/ / a.e i9ig°S... -- tePeR lc /OW 910A3 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 7ePaV.oo ® 5 "Z I 0 y - Z 2 IF TYPE OF PERMIT CIBUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ;ld FIRE PREVENTION NAME OF PROJECT A F I G tI f.LA (Tenant Name/Homeowner Last Name) '1 PROJECT DESCRIPTION NFp& i 3 D r'd N'?P��T/e- FiR� .#9A/,'/#44-e/2 S ter-&./Pt Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER AP/eHYO/ v <LAn' '(- yZeeo' 71 0-get 7i MAILING p e, eo f ,'f$/O E-MAIL Vlealigegmail co CITY STATE ZIP � 67?/9G ome Gbh+ 9`809 N/V ,- Tee/4/ f.eE /�,eoTcali0`I, . 01a., PHLS-e9P q//r MAILING ADDRESS E-MAIL D CONTRACTOR 10410 ,(1e,//®vELTy 4t ( �, e- f3 AaveG LrJ64 4e,.s✓ i Ds�enD 4,19-STATEZ196W 3 FAX J91'-777 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# NOkTCFioo1/P6, 1c9 it‘ i/ -/t-lot 9$7-Do-BI- NE Z-"rich' �i ASTE€Tell, z - qi 898-9/ /f APPLICANT MAILING ADDRESS E-MAIL 28o3D A10 /tieVeE Tr /4 z- Ali, 4,X.e5 da✓'eeefOr eAfire.Cos• CI ST TE ZI FAX -�,1" n2 l � ��©S.� €1t5-,991-7774- PROJECT CONTACT N PHO 15 4'9 q f (The individual to receive and 6a� dM e- ' respond to all correspondence MAILING ADDRESS/V N ' E-MAIL concerning this application) 140317 94V t1 1444 'iee/ "sec a da✓ c t4rteC(' g a CITY 2jfr�ra STATE �19,D5-. X15 O9f 7771- ALTERNATE CONTACT NAME: PHONE E-MAIL :2 n ,i. Dt5e-ri qL -9p-ffi► d eo►n egoriechtre,c, PROJECT FINANCING NI /14 /)FiQ,/ pi G 'J l` 1� OWNER-FINANCED Required value of$5,000 or more IRCW 19.27.095) MAILING CITY,STATE, ZIP A✓' �6"/y ; /0 J197lG R/gr/, 9409, ),,o&-ZQo-'f V 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 4I//fe/7/ PRINT NAME: /, (1E ej ,els, Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application