14-101647 -------- ''EIVED -
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APR 10 2014 *aft * j
"�•� CITY OF FEDERAL WAY PERMIT
APPLICATION
Federal Way
CDS /�
------_______2
PERMIT NUMBER / _.../ l[/ 0 _/ ® / 1--p -
TARGET DANS
SITE ADDRESS �_ r SUITE;UNIT S
• *cam TAvr,cn -4-- , L_
butal .
PROJECT VALUATION ZONING ASSESSOR'S i
TYPE OF PERMIT o BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING" FIRE PREVENTION
NAME OF PROJECTF44-,j6-1S
A1f�l.- (l� ! �`"rd
PROJECT DESCRIPTION r( ALA-461 ��Atj , -y- Re-741fri_e
Detailed description of work to ril1473 4C 1
be included on this permit only __--
1
NAME PRIMARY PRONE
PROPERTY OWNER rigAll CLSC.AIJ 44 t y5 3,174-0d.ai
caV4 Al-e.. S
�.; / c/7 04 •
B PRONE
map . . e�/``�j 4 Zr�I0z0-6gi
V -
CONTRACTOR hi 1� iTd -� i" Gv ' ® ' ..ii K
PAX
•
PRIMARY PRONE
APPLICANT MAILING-ADDRESS • PALM
=V STATE ZIP FAX E
PRONE
PROJECT CONTACT B� .
Z4 C . 77-6 c-o-5-17
(The individual to receive and °� ,� 111
Q^-r"' r '`"�� `� . t,.u..�.'7r
respond to all correspondence / v ( �
concerning this application) � � i 91.G'v P lT. ' 9 7J^
• . PROJECT FINANCING NAME 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE..NDPRONE
(R'GW 19.27.095)
`
I certify under penalty of perjury that I am the property owner or authorised 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.1 certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that the
issuance of this permit does net remese the owner's responsibility for compliance with loeals ske% or Mural lawn regulating
construction or emrironmental laws.
I further agree to hold harmless the City of Federal Wag 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
iA{formation supplied to the ecity as a part of this application. �J�
BIGNA1 JRE: /�/ DATE V n 4/v 00//1
ORBIT NA 1EI b l`I�i 94-4^A PA W I i
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application