13-105424 •
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PERMIT SF MF CO ME PL DE EN Federal y
P
cO253-8MMUNITl'352607DEVEIA
•FRXPMBNT 2538352609 SERVICES AP P LI GAM Mt
w:,;m.cihi=�;ie_rcrunr;.cmn
DEC 0 5 2013
SITE ADDRESS SUITE/UNIT#
331/J6 g Mt
5DC)T4 CITY OF FEDERAL WAY
CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3� •Z5 a �9 Q - �� o Go ,)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING C2MECHANICAL
❑ DEMOLITION ❑ ENGINEERING )(FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) t.{O6;_ TVIZj T FULFk ENT` C -4) LTJ
PROJECT DESCRIPTION 'A it Y fir`' exkSfi NCr S�CINV\Iy, r\Z S‘)$t EM m p,(, !3 Yv�S(".of f-
Detailed description of work to MQ- t .EiJ LAJAL1lj NV) ( A-' e5
be included on this permit only
NAME -/ /� 'v�1 PRIMARY PHONE
PROPERTY OWNER L 4 REALTY q4G-uo2- 7356;
MAILING ADDRESS E-MAIL .J
3333 M/U/ELLON, 57E 35"0
CITY-Z Z(//4/,& STATE ZIP Oa /026/c9
NAME PHONE
5,n 1i 1-1 ill26 5y57 m,5 053- 24 '-a6;g
MAILING ADDRESS E-MAIL
CONTRACTOR i/t� Sz/ Ave �/V�T' Jr/�s r,E� Js.�el� {v�.< H
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
3i1(71.4E5I307- / / 3/ / /3' Vt-$F- `SS--,n-p, ,
NAME PHONE
.5 ill MLI Fla.SYS;;E \ r)53 q -aG.f
MAILING ADDRES
APPLICANT //t?let 51/1'A A4v'y F Si ,74:4Gr�S,:�l 4f�r�,c VI,
CITY STATE ZIP FAX
—14Ga^i &um /e/ 1 g-53-qd.6 -- 3 c o
PROJECT CONTACT NAME PHONE
(The individual to receive and J` J�ra - ,
MAILING ADDRESS
respond to all correspondenceE-MAIL •
concerningthisapplication) %/D& -L/'u` /'�//� EAST".� JP.tTSairCr(eSsMl4i-C1fQ..uih
CITY STATE ZIP FAX
"771CO0/A- vi-)4 (304/34 "3 ey x357
ALTERNATE CONTACT NAME: PHONE ,., E-MAIL
it//la<I VCI Z.) D. 3`D'1&-Ld nvmel-e3m(-0/Q.,(31,1
PROJECT FINANCING NAME
OWNER-FINANCED
Required value ql$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: •// -IA 1 / DATE /24//3
PRINT NAME: ----CE P. )O1 IH-
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application