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14-103451 4621) CITYOF � PERMI P APPLICATION Federal Way JUL 10 2014 CITY Of FEDERAL WAY L PERMIT NUMBER J _ J S _ r l � L J TARGET DATE SITE ADDRESS SUITE/UNIT# 35703 16th Ave S bic-1;u 1'�_.__.. PROJECT�rVALUATION ZONING ASSESSOR'S TAX/PARCEL# $ .[ `t) 9 0 4 _ 9 l 0 7 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL ❑ DEMOLITION ❑ ENGINEERING 1s FIRE PREVENTION NAME OF PROJECT Install lire alarm sv stem ilk I1Cv� aparinlent htlildme, PROJECT DESCRIPTION • Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE ZIP NAME PHONE F r+ tli i A arm ha steltl . Il e. 206-575-1962 MAILING ADDRESS E-MAIL CONTRACTOR 861 1f`lUStI`` 1)6\e Lris a%lroulasolutions.conn CITY STATE ZIP FAX 1 t;1s�\iki \ 98188 206-575-8168 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# 1=l:t�13. 1S 19-98-105635-00-BL NAME PRIMARY PHONE same as abor\e APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME PRIMARY PHONE PROJECT CONTACT KE I toP1'er{..(In11tr 253-753-6660 (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence 1 II1Clustr). Drk,e .rls:difroulasolutions.com concerning this application) CITY STATE ZIP FAX tukwila \ 08188 206-575-8168 NAME PROJECT FINANCING ❑ 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 Iaws 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: DATE 7/8/2014 PRINT NAME: itristt>�Ite? Conner Bulletin#100—January 1,2013 Page I of 3 k:\Handouts\Permit Application