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10-104634CITY OF 'A PERMIT Federal Way COMMNDVtOP 253307FAX 2 09 s 77i�IPPLICATION uoffederalt i.cum ," '" !0_ io4l�3� R$G�f6(�dlvl�DDE EN FP i= i:� 1 \! C NOV 0 2 2GG'0 CITY C) F FE lJ EC-r-�SrL' SITE ADD 70 S 3 o e I STET ` PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL # $ x,33 n0 � % 2- -7 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING IRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) ©bcdZ SAV 1 o %Z i�,A PT- r $ T � uaicc-, NST,¢ L- TT 9 ^1 017 1 (;LE PROJECT DESCRIPTION Detailed description of ulork to S 1.11.- ^- 5'' 6A L -LD& 1 i4 "A) "OD ZQ 0 J PCU (L4 -r (0 AjS be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER QUl%L S ASIU 12� S'(- CN HRC MAILING ADDRESSE-MAIL. -701 S. 3 44>'P— ST CITY -'E0G-✓-A c- WA I STATE ZIP 0 NAME R i{OoD An)ADuct- S Vicar• INL. PHONE Zo(v• 77-b• OgIE$ MAILING ADDRESS (o(00 1ZTI-E A VC=. S . E-MAIL ).5CAlr%e61 r+-4004• O CONTRACTOR CITY STATE ZIP FAX Sc—st� 1 t= W,k `i ZIE(y 767. 2.(0 © 7 WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FED RAL WAY BUSINESS LICENSE # f5-79 1400R 9Sc�l.- Iz/ I / I I. " 106yl1-&09., NAME PHONE (SAO—C- (SAO—C-As C�n)�rrcAC1 o� MAILING ADDRESS E-MAIL APPLICANT CITY STATE ZIP FAX PROJECT CONTACT NAME PHONE (The individual to receive and JAI Sc-wnl &a L_ 2a G•72-6-09 40 MAILING ADDRESS H A -r4 S E-MAIL @ rAcV c1 respond to all correspondence concerning this application) & i O O i'2 -'r ,}-54he61y -co &„% CITY STATE ZIP FAX SEA'irte VJA L1Tf f$f 2o(k 167-2b07 ALTERNATE CONTACT NAME: K21 r�N PARI-wS PHONE 20kr-Mfo • O-iyO E-MAIL t 1G fry t�SCl rthnOCi � Cd ►M PROJECT FINANCING NAME OWNER -FINANCED Required value of $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP PHONE (RCW 19.27.095) _ + /A 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 f led 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. 11 , SIGNATURE: DATE 1A / Z�8 2 o V PRINT NAME: 'JAY 4ch- K C—B L y Bulletin #100 - April 14, 2010 Page 1 of 3 k:\Handouts\Permit Application u..