13-101652 ;,r~oF.: 0 PERMI'SAPPLICATION
Federal Way RECEIVED
!•,, ' r l 5Z. _ C O APR 16 2013
PERMIT NUMBER
TARGETDATECIIY OF FEDERAL WAY
SITE ADDRESS SUl1°A.` NIT
3ogtaf 1LkA k h c kL\ E
$ PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT j BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT r l��aa ,_0.,„.... c„ ,,,,,,„„ s,' �`,_�
ov,-.A \<- 12- if\ 'PeA2.4-rA 1 ti-IA '
PROJECT DESCRIPTION <P
VC description of work to a N. 1 r e k-o 17�5L"+c�V� �j dl�� <PVC \-PA r Nk tN),
be included on this permit only (� 1 I
So 00 C +nnAo t a WOC14- i5 CZE1+I is e\ .
�g r PRIMARY PRONE
PROPERTY OWNER 7"Gt/2 ' �1'£,A i �-r1,2„,,.:42.-44t,,-,',f, w�- p c 3 ) 83/ 73 g q
MAILING ADDRESS �'�
3 0gL/y /4/4-4 j &'( S �(/si b/v�d�c>, Wee4
STATE rF r/r r4 GIVE j/ W t4 Z7 b-v �
NAME / PRONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE N: EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAIY� _ �1 - 1 / PRIMARY PRONE _
` o\)r n J c� ns ( c.; v 7,7 Ca l\
APPLICANT NIfAIINGADDRESS 300 - itt4.
,t,� /L� E v Ywrn c,erv4-ND 5
CnYf 4� 3Psi
STATE ZIP I /) �b FAX
NAME yV,�A('�` PRIMARY PRONE
PROJECT CONTACT
(The individual to receive and RAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
PROJECT FINANCING NAME 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I Ceftify 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 Wag 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 application.
SIGNATURE: r DATE t//6 13
---"-)f-PRINT NAME: /4 I j CA'► L(.45