14-106033 8 •
CITY OF A PERMIT APPLICATION
Federal Way
/ QED
1. c PERMIT NUMBER L 4 _ 0 0✓ 3 F-47-7_ '`O V 2 0 ?014
11 TARGET DATE
SITEACI Uc g/�ERAL WAY
'` (�- igi o S. 320fb CDS
iD'7DRESS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 31 0 trb Cerci Z__ _I,_ Q � - q 2 0_
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINF.eRTNR lu•��n FF.PREVENTION
NAME OF PROJECT A- V��ttL. t, r V L C 1 r {C
DESCRIPTION a''"Nressab e TG G`Qfni IA 0cii)6)1iat1►C J �•
PROJECTI I ` J
Detailed description of work to Add SMQ e Gi de. ?Gne'l g, not,i'GG,Lt.to h iiVl j 141'0%
be included on this permit only 61_ _ `r '-\' ��fhi� 6e,. connP�' i J intdece()lt,_S
M 1
NAnwvie,40PRIMARY PHONE
PROPERTY OWNER CAL, U��IGs a Si'1 ns G-c
MAILING DRESS E-MAIL
CITY STATE ZIP
NAME 06\A('01 'V, ♦ kat-Nk ( C, PH -3 ' 3�
MAILING D E-MAIL
CONTRACTOR �� A 01'/C FF ��/�/�' /� 1/MI L/l�wc.;nC.1,lSkiM�GGm,Corn
CITYsectu il lI E TWAT ATE ZIP \`6�Vy F(rw,V- 32.2' 1�1L4
WA.STATE CONTRACTOR'S WAS krA C2 V GSI,3 12/ 1/I�f ON DATE
L6 0.0e. 101112.4-00-13L
NAME ^c Co G PRIMARY PHONE
lk ^
APPLICANT MAILING ADDRESS Iw 7 E-MAIL
CITY STATE ZIP FAX
NAME / MCI
PRIMARY PHONE z ,/
PROJECT CONTACT �0(K )Y LV.L I L .t A Z�'Sin` J��p
IA
(The individual to receive and MAILING ADDRESS � '� r ME�M,A,I
respond to all correspondence ^2030 /-1'r )4 X`1 `. 5 . ( j Il'�,t��•l/1 UJfnlet�lA SnlnC �lltic[44
concerning this application) CITY ( `,e s W a ZIP
V 1,3L4 '2C �' `t--T2 t 4
NAME
PROJECT FINANCING 0 OWNER-FINANCED F
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 thisisapplication. J/�
SIGNATURE: /�/�v' -� i��//] 7� DATE ` '' 2 r lig/(Lf
PRINT NAME: /"G!'Y\ t Y t fz.. A
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application