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16-101544
CITY OP. PERMIT• AV APPLIGON Federal Way ii ( � MAR 302016 PERMIT NUMBER t fit/ _ TARGET DATE CITY OF FEDERAL WAY SITE ADDRESS `/"�� CDS . 39.3L. 1 fit Ike. S, � ©f SUITE/UNIT# /1 11 I ® 1 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 3, gg7 66 5 0 1 _ O b 4 0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING 'FIRE PREVENTION NAME OF PROJECT F(i rn ar y Res r k a i /Pi a g Ae,vr Fes re.ce.SSe.cA GhreMe a ' S r ; -kfers PROJECT DESCRIPTION �/�� rn { I( P Detailed description of work to f e r /1 . C I I ^q A L� w A!I 6 u ( A$ be included on this permit only J NAME / S Pro Q C PRIMARY PHONE /' (�/� PROPERTY OWNER V 6)(i.ei ri-e- Y r p p '- C l� 05-3 3-66�- p lJ 5Gr' MAILING ADDRESS E-MAIL 3'10 o 1 Ave.S CITYr I STATE ZIP tri WA 61 fOo NAME I rc�1er Cons`t�rttic PHONE lon 253 - �7a1- 7 2� MAILING ADDTSS _ ) {� E-MAIL CONTRACTOR ?053 S o`6 6�� `� CITY k STATE ZIP g03:1:1 FAX ellWA STATE CONTRACTOR'S LICENSE# W /-! (]IEXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# 6BCNAARCH L! / ( ilk .26-c 'TO lV 3 436-13t- NAME ME (}� PRIMARY PHONE 5--6 MAILING ADDRESS APPLICANT R �^ 1 EMAIL j �Q .55 s 2©b f- c'Sa � of-dui CcAitc,ct.or;con, CITY K STATE ZIP 1I1‘) VO e® 3 FAX NAME (` PRIMEY PHONE PROJECT CONTACT r"I L SC o C `d f5 -32 Y-23:14 (The individual to receive and MAILING ADDRESS_ Ur E-MAIL` respond to all correspondence '5`� S 1 O 5 , e'S�13e e0:4 l+v_cr t‘. Orr( concerning this application) CITY !L ' Sa'ATF_ ZIP c - l FAX `J NAME �,`//pt. cT PROJECT FINANCING 0 OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.29.095) 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 1ccity�as a part of this application. p J SIGNATURE: �Litize ('-r DATE 3" I /I PRINT NAME: E r,'e Sofas, Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Perniit Application