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15-103740 ary OF C.''- ..:Y PERMITePP EIM4T4ON Federal Way JUL 3 0 2015 PERMIT NUMBER I _ 1 O3 ---7-- 4-.0 rp, _ CTTY OF FEDERAL WAY - - TARGET DATE CDS SITE ADDRESS UITE UNIT# ' G ? l 1..LI Ai , , • a03 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 4,)©O -tom 1 14 0 - Q) r), 0 0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION E ENGINEERING FIRE PREVENTION NAME OF PROJECT \IN P.\\RA' ,•<,..YN.-, . 5 PROJECT DESCRIPTION l i3 R- cA f 2 11-.4e. (0c04,,:,..1,•:`'1 r' "-r �t 6 Detailed description of work to �f�vr } a, \\ 1'` ,, y� be included on this permit only NAME is L PRIMARY PHONE PROPERTY OWNER ``'IS ' ck Yl,4 (1+1- C �( 2e)6 -L-1o9. (- i 1 Z,L MAILING ADDRESS E-MAIL _I \\\( () N. f_7__ -‹.—v.' `)1 CITY ,� STATE ZIP ` NLo_c-111 . \ Ci.-1Y) ll 1n o-(y Li C__ PHONE fiJi �J j cO3 ) MAILING ADDRESS ) E-MAIL v. 0CONTRACTOR ic- )-14-c-' CITY STATE ZIP FAX \AA ,k) G C-t-( 0-2 9 Ci-C-)4',r-2, WA STAT NTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# LE l_ -`d`"� (^ ( I 3 ( 7 7 NAME --- PRIMARY PHONE C11(:).5 nel\i i < 7C - 93k- -31cc1/2 APPLICANT LING ADD SS E-MAIL CITY STATE ZIP FAX ,\\ C 0_17---<-1-. (A,1 X c (r3f"Z. ) NAME PRIMARY PHONE Z PROJECT CONTACT S4 it <<,."i c:kp Q I,f tS.ti,k (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME 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 r iance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this pplication. SIGNATURE: ��� DATE 7) z2'/z 7 3 I PRINT NAME: ( L\ 1' ,.e-.4 etA) 1 S