Loading...
13-101699 0 I CITY OF PERMIT APPLICATION Federal Way Appilcv3RECEI'RECEIVED � � PERMIT NUMBER I 7 _ [ 0 1, 0 0\ (1 _ `�'© APR 18 2013 TARGET DATE CITY OF FEDERAL WAY SITE ADDRESS SUITE# '3006 Pct t`Cj x'- E . PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# (100 I 50060 - 01120 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECT Ce leb ca. (l,l n $14 clt 0 PROJECT DESCRIPTION Ac A into 4 '. -' Detailed description of work to 'ns/h( be included on this permit only NAME 1 PRIMARY PHONE PROPERTY OWNER �NHa`C i G 5 /�/ M��l 11 10 I V•!" .1 1'v ' l F�.Y\ g`� V E-MAH. r \ 1 1 SO ZIP979( ` ' NAME -6) Alarm�- c \\�lA-icshtnc .. 9z.. , CONTRACTOR MAILADDRESS v- rpi� \l�'W,.l S.' CJ E-MAILlUG1n®LYs\te 41 M CITY 1'C qA. ZIP/��1,31,1 -�w_ Y.,..,^/I� WA Y�L MS I b d C.3 ( l T 5 $4J�/r-I O (� I�D.Bk NAME q1 0.)1 VL 1 •C*', •1 �YW PHON - �7a�/ (J .. E-MAIL APPLICANT MADnvGAC"'W /"`I9 `$$� /I S .`�y±I mmc1It..yAn04511-44 ,M'e'h CIT c1 t ri/FI ZIP 111 l�� ( MV`39V_` 7 11 PROJECT CONTACT NAME 1 lC(I< I��/��!.)G\� POCIO RIMARY 'P�8- fe (The individual to receive and MALLIN D S via E•MAI respond to all correspondence �1�� �y� • 1ciloc��azhi�te.6A 0,161 concerning this application) CITY 11.% TA s1(_,1 ZIP N13 P�IJ[) 33-79 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 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: I ji!�7� /_ 7-(�T/� DATE � /3 PRINT NAME: Mack' 6 V1 `Sc,on Bulletin#100—January 1,2013 Page l of 3 k:Handouts\Permit Application