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12-101865 [ 2 _ 1 0 1 . & .5 CITY OF A, r PERMIT • MF CO ME PL DE EN FP Federal Way COMMUNITY DEVELOPMENT SERVICES APPLICATION RECEIVED 253-835-2607•FAX 253-835-2609 www.ci�(f ederalwau.com APR 2 6 20,2 SITE ADDRESS SUITE/UNIT# 33702 ZI �+ AveN�� SuJ CITY OF FEDERAL WAY PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# C D S $ 0) 935. 00 q 3 0 1 0 0 - © Q I o TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING X FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) Fre_d N\cyev Fed ei'A 1 tk)A-y 6 -6( III VA-N i 11e She PROJECT DESCRIPTION g e 1 P 4e. ex F. '-1-tW�t "- I V`� 10r-I`�J It l�v v AJ - ) Detailed description of work to w AU l S A d_ -6 1‘..,...1 1.,i be included on this permit only 4 46 be /V eta Q ui GtL RONS 4N/1 e- PRIMARY PHONE PROPERTY OWNER t red in eyPtr res, INC- 503 -7F7-3//-2-> MAILING ADDRESS E-MAIL 3le C_830O 6L_ 2_2.-Nd)1 STATE ZIP Pele-41 c ©,Z_ R7Z z NA /'>'I/`e-4 ie/d ;.Me, 253--S5 /-Dd 30 MAILING ADDRESS/� E-MAIL l �+ CONTRACTOR T &7X 03.eq Es-tio/ 71'IVglieeshiea,tC CITY/ STATE ZIP FAX •.! PAr))vv' W4 903,5f.. Z3- /-77B7_WA ST CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# J`es )Fi 114/r) J��a]z�le '�I IZ / S> / /Z20-10-101(01/2-00-8L NAME I V J T l m /4�i PHONE 25.3-e-5 i 62&3ó APPLICANT MAILING ADDRESS E-MAIL P2 X 23e39ts�iri�l i`,vi`� �iekl CITY STATE ZIP FAX J ��+v' v� NI+ 70335 _ - 3-051-97gz- PROJECT CONTACT NAME/ , ,' J �^) PHONE (The individual to receive and 54ils A!DI p L,1 C`�' ' J respond to all correspondence MAILING ADDRESS E-MAIL concerning this application) CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME ci 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: j' DATE _%4 (�/ )Z PRINT NAME: eSm f`: / ',11 Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application