11-105159Federal Way
COWw,NITY DEVELOPMENT SERVICES
25:3.835.2607- FAX 253.835 -2609
:�'ll.l? (IitLri pil ^h).i 1•ti�y CClq
*PERMIT
APPLICATION
I L - 1-0- 5-1
*MF CO ME PL DE E FP
lI
A r, r� s i
Bulletin #100 - April 14, 2010 Page I of 3 k:�Handouts\Permit Application
SUITE /UNIT X
SITE ADDRESS
a E R L
V Wf`491
10%0 J-Ct{ 3 �0� ST.
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/ PARC L #
$ r-
°I 2 �? � - �? c
1 n0 c�
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
(Tenant Name / Homeowner Last Name)
L L 0 LA'T % A '
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAM
PRDOARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E -MAIL-
CITY
STATE
2IP
NAME
Patriot Fire Protection
PHONE
253- 926 -2290
MAILING ADDRESS
2707 70th Ave E
E-MAIL
CONTRACTOR
sTATE
za'
FAX
CITY
Tacoma .
wA
98424
253- 922 -6150
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY =snmSS LICENSE #
PATRIFP099CF
10 / 5 / 2010
19 -91- 101988 -00 -BL
NAM
PHONE 253- 926 -2290
Patriot Fire Protection
APPLICANT
MAILING ADDRESS
2707 70th Ave E
E -�D'
�� Tacoma
STATE
wA
ZIP
98424
FAX
253 - 922 -6150
PROJECT CONTACT
NAME
o�.a QA�cA
PHONE
2S - 124 -224v
(The individual to receive and
F-MAD,
respond to all correspondence
MAILING ADDRESS
w w A S CwT a rk ct
concerning this application)
CITY
"ATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E'MAD-
PROJECT FINANCING
NAME
OWNER- FINANCED
Required value of $5, 000 or more
(RCW 19.27.095)
NAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. T certify that to the best
is true and correct. I certify that I will comply with
of my knowledge, the information submitted in support of this permit application
by the issuance of a permit. I understand that the
all applicable City of Federal Way regulations pertaining to the work authorized
for compliance with local, state, or federal laws regulating
issuance of this permit does not remove the owner's responsibility
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 claiml, which may be made by any person, including the undersigned, and filed against the city,
the including its and employees, upon the accuracy of the
but only where such claim arises out of the reliance of city, gpicers
information supplied to the ci a of this application.
SIGNATURE: DATE
A'L G/�r
PRINT NAME. 0 41t wJ�
Bulletin #100 - April 14, 2010 Page I of 3 k:�Handouts\Permit Application