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15-103783 t REC /ED4110, CITY OF . 30 2015 PERMIT APPLICATION Federal Way JUL CITY OF FEDERAL WAY CDS PERMIT NUMBER t 5 _ 1 0 _ TARGET DATE SITE ADDRESS Ave- q8 SUITE/UNIT# 31515 16-1 A 5/ Fehrq/ '�Q/ / �l* / 3 Warehoc2,5c PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ •/C12, 8 3 q l— 00 - 00 ,9. 5' 0 - dO9. 5' TYPE OF PERMIT ❑ BUILDING El PLUMBING ❑ MECHANICAL El DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT 14.5741/ q new /re a IQ-Ai 51st Po 14 4/7e PROJECT DESCRIPTION ,A ' ''^^ Detailed description of work to Vv a r e Y(oU S 2✓ on/y be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER 4 le)( /\a refs2_06--2,2,, -22j/ MAILING ADDRESS E-MAIL CITY / STATE ZIP PHONE NAME I,/, /C/s�✓J/ /Ll 425 2Z3 -3( 6 / P° MAILING ADD S, �• ,Ao / �E,- L /�J CONTRACTOR 125/5 /-f4 / © �Tclr1/G( @ f kir&-S ° C c . CITY/3e//`"i/12FAX 2.7..1;-Z23- 3/6 s' WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# Kt-EPPL)''-93gC6- z 4 /10/3- NAME APPLICANT MAILING ADDRESS E-MAIL 12.5/5 /�/- �( l $ ,Jr /o/ dGni�I C� /!17p$.. ori CITY �C /fe ✓ l V' STATE (�-- ZI (moo s FAX 4 -225- y/65- CJ 5 J� PHONE . PROJECT CONTACT NAMEIsg4 I-c I C/(p r 6 q 4 z 7 Y- 9- I - 5-7 Z (The individual to receive and MAILING ADDRESS , / E L respond to all correspondence )�-�/� G/ �e� �� ��f` �� (' C17/S 1:%'/'f,Com. concerning this application) CITY 6 STATE ZIP FAX t�/Part vqt - 91,o Q .. e./t)--- /-sl 04 NAME PROJECT FINANCING El 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 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 r liance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of 's ap. cation. SIGNATURE: DATE /3©/ f PRINT NAME: iN4 . / e/ e/ i"/ Bulletin#100—January I,2013 Page 1 of 3 k:AI-Iandouts\PermitApplication