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13-102258 ,r • RECVED nTMOF.1A' PERMIT APPLICATION Federal Way MAY 2 2 2013 CITY OF FEDERAL WAY PERMIT NUMBER/3 - L D, " - h TAItOET DATE SITE ADDRESS SUITE/UNIT# 33L1 oaC Aire 5. ICC) PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 2. �° q 2- _6- 1 - _ 0 _L TYPE OF PERMIT ❑BUILDING ❑PLUMBING ❑MECHANICAL ❑DEMOLITION ❑ENGINEERING [ ' E PREVENTION NAME OF PROJECT GO tden c764- t C - G G6 PROJECT DESCRIPTION it2rtcnl f.11"1 S64- LI—r._ C torr , Z.horn-51(61:05,^ 4r/horn/ Detailed description of work to MC'Vbe . I�G.t(e,Ss �[�(4e s / tirt mne „'L be included on this permit only C1oor 1�_ l rcMdvice b A�,In , J� r�lll(��illl:��� QI.�+ y RAA�C:���� PROPERTY OWNER NAME &©'uP,� U tone_ �.Lt- PRIPHONE MAILI'331 bD q�k Ale , 4. I114 ADDRESSL 4‘I STATEMAU CITY rig eta x i � MAINE vjac) in•�o r\ Mtarra .11G 2(,32 32.ST CONTRACTOR MAILING 4V SO 1&p OA Tial S • Whita:l 0Cilfl NiVIS 4 l'Atial) te, r It 4 ZIP cit. t F_{ *" 3Z2.• %1LI WA STATE CONTRACTOR'S LICENSE# TION DA rEDERAL WAY BUSINESS LICENSE# /Asia.. r2' Z LS Io /ee i3 Z.�•bo• bi62A.cb i_ N \# occhi c`iA 1os`rn.Litt. !lx I 3Z APPLICANT alAu IN° S l'c NYE(l�ikn4'�CJI�t'C + rw, ,1e I� VA '�Q�U - 'zc�-322—'72.IN PRIMARPROJECT CONTACT NAME (6 i0(t(k*tsm/Mack iV14;(.tt.JG� 2ltib PRONE 3 (The individual to receive and Y'n'INDRISS , k ` respond to all correspondence .]v/krill c \'JC. r✓` Mm�,1�l,Y.[A g1�/ili11�ir1�Orlw:h4 concerning this application) CITY O t IT TLA wq j 3`( aloi• 32.2.-(72 tit PROJECT FINANCING NAME C� WYt �L(5 t 0 OWNER-PIIANCED Required value of$5,000 or more MAILING ADDRESS,CMR,STATE,ZIP PHONE (RCW 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.I 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 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 ap—plication. SIGNATURE: L� z..-- DATE 5 22' 2"�3 PRINT NAME: MON.C1( 1 t/qL1C'7.'�14C'tr, Bulletin#100—January 1,2013 Page 1 of 3 k:Wandouts\Permit Application