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13-100847
r _I28L7i- CITY OF PERMIT SF MF CO ME PL DE EN FP Federal Way RECEIVED COMMUNITY DEVELOPMENT SERVICES APPLICATION 253-835-2607•FAX 253-835-2609 uuir.ri;uo�Icricrui�rnn-�:n -----__---- _ -� .-EB 2 2 2013. SITE ADDRESS CIlYZ5YPEt5TEtiAL WAY 3aa�S' 3a''-4 4 CDS PROJECT VALUATIONZONING ASSESSOR'S TAX/PARCEL# ^ a3, ©agO D• 2 54 (95 _ cog-0 O _(X� TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING prFIRE PREVENTION NAME OF PROJECT /� y (Tenant Name/Homeowner Last Name) `l J /ej' ( 1 \ `(eer�,(�,V,1C 1(` ¶1 els :S• N o'4'4 Reloco•�►�� ex I-1 lF1a.G.P �-o d�}a c e rw*&..11+ . PROJECT DESCRIPTION - t CCo `` _ Te Detailed description of work to ne.vA .1 F. •. Sr.. 4r AwAa.ort ►MovCthe At O."A wit t Ns 6.1 l► nG be included on this permit only 11e.� tlo��{►ca} ►o✓', a41t tel ce 5 r irt1peove44,vv. . NAME \ PRIMARY PHONE PROPERTY OWNER QGlJ \Ta aob 9ss al73 MAILING ADDRESS E-MAIL .3 ?ac Ave- CITY STATE ZIP 'TN CaANA. W a cA8 4D NAME PHONE Co Nye. t%os,Ir �echno�a,�e.� Lias-ala - aaso MAILING ADDRESS E-MAIL CONTRACTOR 'SO S1‘...1;kvcA1( Ae• S. CITY STATE ZIP FAX Re�tror \Na 9,8057 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# ConvgTLC: 4 i 8 / y an-or- (oag38-oo-aL. NAME PHONE rn,LkC,>e.i wa.t ker k as s6'i SO 6 q APPLICANT MAILING ADDRESS E-MAIL 'AS O Skw-144c,t .. Ave- . .wwliar co„, rSI,41•.c0, CITY STATE ZIP FAX telN \A)g**. e1BOS"7 PROJECT CONTACT NAME PHONE (The individual to receive and Sohn au,'4444,11 a1D aSS 3848 respond to all correspondence MAILING ADDRESS 1 E-MAIL concerning this application) S�.A 1VGA Ave_ S J�l^��VIt k c..fle coAve."4,4 . c..01 CITY STATE ZIP FAX RfiNran wa 4goS7 ALTERNATE CONTACT NAME: PHONE E-MAIL 61\ (A,e( \A) LZe� LUC goy CO‘9 PROJECT FINANCING NAME ❑ OWNER-FINANCED Required value of$5,000 or more IRCW 19.27.0951 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: NN�,I / .�C�(.� DATE 2./227,3 $i PRINT NAME: t L�a.C, WQ / OL:� Bulletin#100—January 1.2011 Page 1 of 3 k:AHandouts\Permit Application