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13-105724
REOIVIVED • CRY OFA DEC 26 2013 PERMIT APPLICATION �� Federal Way _A 11.�� CITY OF FEDERAL WAY i Ap °R®j i CDS � �-, l PERMIT NUMBER 1 _ / 0 5 1 Y- FP TARGET DATEr- - J SITE ADDRESS SUITE/UNITII 1 905 S 308M 54- PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL If $ 739 2 5 0 3 o a - 0 0 15 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING X FIRE PREVENTION NAME OF PROJECT Pot-T Dt AA /tPar -rrt.ut I-S Adel t�• / PROJECT DESCRIPTION /'del ill Td,,t is ct -7 f F5 6ek i S4i'iij P rt 1¢(4CM S Iff ketal 1-6 Detailed description of work to CO 1 vitro ca f r Farr at`4 rrr1 5.9 n q I S be included on this permit only NAME PRIMARY PHONE ! -7 PROPERTY OWNER Cq p th cc...? Prop rop as 1 c 51 t_./...C. 2 06- 10 7 10 4 /1 MAILING ADDRESS rE-MAIL i4T7NV: k:m l�'�12zvtcoo P© Sox 23601 k%i...,.. ZNc4gatel.cvN1 CITY STATE I W i Zggo' 3 NAME,MPHONE / 1011Ak r7/..rni 2s3-y73- 331Z MAILING ADDRESS E-MAIL I CONTRACTOR Sq// OrcAarO, S f SgCE-4 rINVIAil;q 4j�rin.cew4 CITY STATE ZIP Fla Taco,nA -wA 181167 253-`173-`155Z WA STATE CONTRACTOR'S LICENSE. EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N f'40 t4NTA*- 94C PE 10 / 5 / II 10-05-140541 -cO-BL PHONE NiTew, . ;n /4-1crnI PRIMARY 7$I Z APPLICANT MAILING ADDRESS E-MAIL 5//t Orcho,rA 5.1 xfr'eer@Mown/+4.441kr.i%.Cnp STATE ZIP l,tco/KAN - -'l�'1/44- R8`lb7 253-473-Y55Z NAME PRIMARY PHONE PROJECT CONTACT 5(-evtr‘ Greer 23 (73-'3 /2-- (The individual to receive and MAILING ADDRESS 1 E-MAIL respond to all correspondence 5?"! Drcilg rel 5T -59 rem/Q 010 ,4 0,lq/wvi.Goal concerning this application) CITY STATE ZIP FAX 7;CAwtq (Alt+ 9$(( 7 253-173-4ISSZ_ PROJECT FINANCING NAME 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: ,f5Z YI .."7...:4, 0"-.7--- DATE 1 q-. I ` -1 3 PRINT NAME: SPt,vC lI err c a r Bulletin#100-January 1,2013 Page 1 of 3 kAHandouts\Permit Application N.