14-100694 • RECEIVED
•
CITY OF` FEB 2 2014 PERMIT APPLICATION .�
Federal Way y 4
CITY OF FEDERAL WAY M`
CDS
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PERMIT NUMBER / —
4 ((( TARGET DATE
SITE ADDRESS3�S t t1
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PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
39)0 .7- S 1— t Z D - a U 71-
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBINGOf0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT R oo - SIE \Ac Lu � p/ 9-çj
K att (I��l r ' (Aki J 1 CA-Nt {ANAL i N) CIVA-101
PROJECT DESCRIPTION j O A n i A 3 T� ) /�
Detailed desc ' tion o work to /'1+J 1'j'1J , J�j �%�+ 1 V �i�� f '�'� `N Q'�J61 t `'
be included on this permit only t
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SiAbiCC P(3 r4 t c c ,PAN,A
NAME �, PRIMAR PHONE
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PROPERTY OWNER 1 6f VL? J C 2
LAX- ( k g '03
73Lrsic CRESS 1s. /may s
CITY✓ LA �1 1 STA r ZIP ci . __" 33
NAME We 7 C- Y w i,`J
PHON$., ,�6��M1 4��
MAILING ADDRESS 40 i p S r § ,..i-m f_ - f _w�.
CONTRACTOR S (wi C�/il\.`.`G'IL\'�
CITY` �� STAT ZIP78 ,,rr/h FAX ko 76A /7-9 9,
WA ST T i 6 S jIN - � /0�vN(DATE_,/ l __...FED 41- l V1 14 LICENSE
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NAMES+v/ c(� �-,„, TeAm i,� [ PRI HONE�1`i y� ^�
APPLICANT LING G AADDRES ,�`y11 JJJ14/� '�F{`[,�1l'' \"!�� E-MAIL -�(j \7[ �Vp
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CITY -` STA'A1F ZIP�IJ' �+ FAX
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NAM //- ' ,`/,��\{J .PPRpIMARY PHONE ��(
PROJECT CONTACT (' IG r P)� v0 6 �s 2—) T
(The individual to receive and MAILING,�D��REss �� , E r�eAI �C? +
respond to all correspondence "r"U 7. !
concerning this application) CITY c 1 .,{�,, / -._— STATS ZIPq 1 Fy✓� �,
qp?
SIO
NAME
PROJECT FINANCING 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 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 rise out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the a part of this application. ff S
ifSIGNATURE: DATE 2-11 '
PRINT NAME: s7W \. I4S
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application