14-101347 COT OF 1 .. PERMITOIPPLICATION
Federal Way kA R 2 5 2014
FEDERAL WAY
PERMIT NUMBER ��— o 7 3 -
_FPTARGET DATE
SITE ADDRESS SUITE/UNIT#
33'2(0 T' Air s. Fiatoo.- t.014-1
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# c[
ZIS O 1 Z 7 0 - 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ENGINEERING VLFIRE PREVENTION
NAME OF PROJECTCAcc b' i Tt
PROJECT DESCRIPTION Cin..nte. Alt �a-a-i s Iv In t e . i-e t- u .<
Detailed description of work to �i ofeC Aec..* Ai h2(4) lnl•.\\•
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 4.01c.1 t (Al/CPI- QA+ Profe I' t s
MAILING ADDRESSll E-MAIL
400 (lr,tve_rs F� 5`• 1!4 te- n?
CITY STATE ZIP
See,tt1-4._ cmA-
NAME PHONE
P4'16-lOT F iLt IOrtkt e4" ?5�-926-225p
MAILING ADDRESS E-MAIL
CONTRACTOR 2-70'7 7o" AAM- £ 3011‘401 a eak- .)kc fQ .CON."
CITY STATE ZIP FAX
TAt aw.k WA- 5 S-42•4 2. 3-1Z2,-6/r—c)
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PAT2\FPfi611cF /0/ c //j/ II- 91-to%Wi-c)v
NAME PRIMARY PHONE
,A1144C 4 f (Set .-C
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT O\A-v. ) C.-"- ZS?" 9Z 4- 2 2'!v
(The individual to receive and MAILING ADDRESS E-MAIL �^+
respond to all correspondence - ' e P44(I C T�14' • Cq.�
concerning this application) CITY STATE ZIP FAX
NAME /V/I4
`/ OWNER-FINANCED
Required value of$5,000 or PROJECT FINANCING v/Imore /MAILING ADDRESS,CI4Y 4 STATE, 0
ZIP PHONE
(RCW 19.2Z095)
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 as art of this application.
SIGNATURE: DATE 3-?v
PRINT NAME:
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application