Loading...
15-100573 C;TVOFPERMIT APPL .} ....ea ,. ._ ,,ION Federal Way FEB 05 2015 /1� PERMIT NUMBER l 5 _ 1 0 L/ 5 F CITY OF FEDERAL WAY _ TARGET DATE _ CDS SITE ADDRESS SUITE/UNIT# /x/5/ SUt'Tt/ j44 5T/(r(T �'e -PF/t/+i- G', i uA PROJECT VALUATION ZONING ASSESSOR'S AX/PARCEL„ g. 5 z9I 5--- © ogv TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING D MECHANICAL ❑ DEMOLITION ❑ ENGINEERING KFIRE PREVENTION NAME OF PROJECT (= DC:X/1ft 1-.//9Y ee)S5PUG S 3L►>G tekt PROJECT DESCRIPTION 5i Ap vvr rl/t.c-- 4-64,e,41 '7/4kie-c, /4 N7 /At//7-4 7A, L. Detailed description of work to `-2(.*-L//C.CS be-included on this permit only - --- NAME 0,,,) cc-40 .�/NL_ t.._)1‘,)/ C II_A+55•".,5'LS) PRIMARY PHONE PROPERTY OWNER a 1 C(1-c-)uQ G C- Cur AA-=10-s el 25-Sic - 2 5-L3 3 MAILING ADDRESS E-MAIL /(&4'<5` NE 47' S'7' - Sc', C- 704 CITY STATE ZIP i36Z-i_C,/vC c✓l4 eit e `'7' NAME PHONE c t lic Sr -re-A L/C-5 T- /tirt_ 25-3 -'633 ' /Z (t MAILING ADDRESS E-MAIL CONTRACTOR Zsb(,> Fitv.vr79Cx= 46 ,J/ 54o--e- C CITY STATE ZIP FAX ----1- /I-CIr/c_ 144- 945091 ZS 3-735'- s /,' WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# l�/1205•-,/ 0f5 L--(✓ / / —_ NAME PRIMARY PHONE (tltc- SYS rz=7as i 'c---. r /A✓C Z.3 — %3 3- /Z-Y(11 APPLICANT MAILING ADDRESS E-MAIL %5&e 010u rkc.' 27 &) 5v/r(---- C___ CITY (-- CITY STATE ZIP FAX _ ; AC /�F /L c�l� ' 0'/7 z 3— 735- —sa'/3 -- -- - -- NAME PRIMARY PHONE PROJECT CONTACT /1/4 C-/�Ai-C-Mr/A-} .25--:S -S.. 5- /2 (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence 2_466, FIto V 77 6c,- C`P 10 . ✓/T(- Mik-ivC 1•IcIC-'S>^Srf Ns r.ae Ca`-) concerning this application) CITY STATE ZIP FAX Fol C/f=/c I,/A- 4011-1 2S-735-- c4//3 PROJECT FINANCING NAME C.-A•._,, �{JC(Cd�l W y CICc SS1s-<- / c_.? OWNER-FINANCED C./c- t 4 ,-.).:NC-;1_,_-_,P -- Co,rnPInti»cr'S Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RC W 19.27.095) IySC,'5;S` h7G y '" 5rltcZi,4,v1lr- 7W 5ezLcvvc- /zS-SaesS- Z5Z'S 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 o .bf the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the ity as . p art of this application. SIGNATURE: - _ DATE t TF/S'S PRINT NAME: / r4 77" 4/ 44/3' Bulletin#100-January I,2013 Page 1 of 3 101-Iandouts\Permit Application 1