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15-104383 RECEIVED.. - 104 '� 8 3 CM OF PERMIT SF MF CO ME PL DE ENO Federal WaK G 2 8 2015 COMMUNITY 2 07.FA 253-8 SERVICES APPLICATION .. 253-835-2607•FAX 253-835-2609 www.c9voffederdegnOF FEDERAL WAY CDS SITE ADDRESS ,!} ��i✓ G'©3PROJECT SUITE UNIT# /1/ UATI ZONING ASSESSORS TAX/PARCEL / - © Q TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) � firoP el% /Y''f myt..0)( F/ 1"- lT n(1.1?' t�*lt' JZl✓ 1 - f n ✓'M/ i //- PROJECT DESCRIPTION /� ry!_� Detailed description of work to ger-671/77,7!N(f�u� Kl�1'�/7 /F✓in grid-./" A/!1/U6 tvheSt- be included on this permit onlyt//`- r3&j') r7 Y7, i/677`f tv T �,/ D/ k TLy gitoz r Av 311 /41.74)11,633.413646 /WA/Ira, "4/5-1 ,MB77nr 4r ADDJ4-e AOAA , c�GG�`s'Y(-4s l- PRIMARY PHONE PROPERTY OWNER ESS his_ MAILIA Th✓G/ 9 /�-� E-MAIL CITYF n ST /� 06,5 lP CJ NAME co L�►/ 1{ PHONE (y;a. 7q.%_7 Z,3 MAILING DRESS �/y ,r / E-MAIL ,y CONTRACTOR /96 G� / F `� ' _'CSI r'-^d^• re!fit) /Nceica i CITY sitz J ') / 66 --W-47/ WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# NAM 't/ l S C G,-3) Flo-7 z 3/ APPLICANT MAILIN.�AD," S . ` �' e �7 E-MAIL > 1/ 1'7�0 bAl-J r i `'7r,:034?...„ e- �% -//z e re;//-7017621-�(M' CITY �<`` VOL__ ZIP Y (/ �3� 7ie4,7 PROJECT CONTACT NAMB-X �V/`//I- PHONE // (The individual to receive and d/✓/l� !✓ hT '�2j/� h.,� — �� respond to all correspondence MAILING ADDRESS ('j !e /72— /2- E-MAIL concerning this application) re(Jc7e i/! �i � 7 CZ 3) `764 726 AL ERNATE CONTA T NAME: PHO E-MAIL � i (ZS"3)`7 7231 ;nieOL'l2 @7 ,Cuwa PROJECT FINANCING NAMEEl 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 ,Part _-.pplication. • SIGN UAT RE: �� DATE 0 S PRINT NAME: vn/M� �✓// J f Bulletin#100-January I,2011 Page 1 of 3 k:\J-Iandouts\Permit Application