12-101281�-7 _10(zgI
' PERMIT EN
Federal Way ����;��%�
COMMUNITY DEVELOPMENT SERVICES
253 - 835 -2607• FAX 253 -835 -2609
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APPLICATION
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MAR 21 201.2.
SITE ADDRESS _
s. 320 " sT - crt C 5
PROJECT VALUATION
ZONING
ASSESSOR'S TAX /PARCEL M
$ 14,000.0°
O 01
TYPE OF PERMIT
0 BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING IeFIRE PREVENTION
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
CMEC,001)S
PROJECT DESCRIPTION
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Detailed description of work to
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be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
SCA n9 C. C.R C C
MAILING ADDRESS
E-MAIL
CITY
STATE I
ZIP
NAME
PHONE
RUNG_ CotitST CT►o /,.,1
2-613"bit-17.12
MAULING ADDRESS tt
1 J. 2o &4-b ST•
E-MAIL
CONTRACTOR
CITY
)T
STATE
W
ZIP
11605-1
FAX
Z.s -i 1 -I
WA STATE CONTRACTOR'S LICENSE 7M
q N I I 2,190R-
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE M
NAM
PHONE
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MAILING ADDRESS
E -MAIL.
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAME
PHONE
MAILING ADDRESS
1 ,S. 'Z'0(y 4 S714cET
E-MAIL
YDE 0,o ARLHE2Cori
CITY STATE
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ZIP
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FAX TIGJ C.TN O N • Co
253.el itl
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
P-%Lr= IIIYAIL
PROJECT FINANCING
NAME
0 OWNER- FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAULING ADDRESS, CITY, STATE, ZIP
PHONE
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 apart 4f this application.
SIGNATURE : - DATE .3 /Z I /Z 0 ) Z
PRINT NAME: l�E Ji E 6 A A O
Bulletin #100 -April 14, 2010 Page 1 of 3 k:lHandouts\Permit Application