14-104459 •
CITY OF PERMIT APPLICATION
Federal Way REINED
14 - (� 4 4
S G pp AUG 2 9 2014
PERMIT NUMBER— — TARGET DATE CITY OF FED FRAI WAY
CDS
SITE ADDRESS SUITE/UNIT
.014 32ND AVE SG,7o-#-) FEDEi2AL wAY, WA 91,003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 41
/00 ,21 s 4IS? o - c; C)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X.FIRE PREVENTION
NAME OF PROJECT SOVN0 f f4SC ALAR ,g /ETN 1-..r.
PROJECT DESCRIPTION 01 bAT Fr T NE PXT six/4c. SI Cviccr4 SYSTEM TC
Detailed description of work to f CCi7ev•OpATE THE Net") W LS AvO C E1
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER PEic'' b G - j J'O t itsc,4 %c tope p ( 3-3)Etq- 7/04 x \
MAILING ADDRESS E-MAIL
921 S• 3Lt P-r(4 sr p e sovAd t to 9e:u br-cow,
CITY STATE ZIP
9'W-ft- WAY (AA 9)co"
NAME PHON -_---- _
SrfvsrN FirRE Sysr6rits ; 3)g2G -/660
MAILING ADDRESS p-MAIL
CONTRACTOR
11� T +A VE
CITY STATE ZIP FAX
WA STATE CONTRA TOR'S LICENSE# EXPIRATION DATE FEDERA WAY BUSINESS LICENSE#
8)'11fiff 16,CT �( 2 /141- /9- 7-ass-oo-I L
NAME PRIMARY PHONE
M ATrvwiLLF-
APPLICANT MAILING ADDRESS E-MAIL
EPWAE AS ABovF
CITY STATE ZIP FAX
NAME P IMARY PHONE
PROJECT CONTACT M A rt Iz)^J KLI! PS3) 2.4 r
(The individual to receive and MAILING ADDRESS ,� E-MAIL
respond to all correspondence \tO(o T A.vc E MKcJ^rE,Ccm
concerning this application) CITY STATE ZIP FAX
TlAC.ctMR w►A 9%LI
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 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 arise out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t. th-ci -%s a part of this application.
SIGNATURE Alir, DATE S12-9/'2- y
PRINT NAME: rI ATT gLkJ t
Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application