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11-100746i Cm of Federal Way COMMUNITY DEVELOPMENT SERVICES 253- 835 -2607• FAX 253 -835 -2609 www. cit uo((ederalway. rnm _�L- _L 0- 0 :�_� PERMIT MF CO ME PL DE Ej FP VE& APPLIC FEB 2 .3 SITE ADDRESS &&) S . 33 ` -(,ree -{- CITY OF FEDERAL WAY SUITE /UNIT M PROJECT VALUATION ZONING ASSESSOR'S TAX /P N $ J!5 - ©5�_ A Z �, 6- Q- 0 2 ) TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT (Tenant Name /Homeowner Last Name) / D,-) to Jan `e Q Pr A�-- /�B� le,*Ade/ PROJECT DESCRIPTION Detailed description of work to AA 5P*- AfV_tCK. PQo-T q� u Ki bt 0" rJL AIT Q ooM p Ir QH LC A.)GI 1D , l Ss R I LD i eJ !.. )1 E vJ +11 F IJ be included on this permit only •►�� R- I t A PROPERTY OWNER NAME P p h1 :ro tj D N PRIMARY PHONE MAILING ADDRESS 20 X 300 E -MAIL CITY �G P4 STATE &I T ZIP 12 9 54 3 NAME CE -�J r- Q _53 1 . T - ! v 6 Q a MAILING ADDRESS � (1 // m MAIL - �%P�n I CONTRACTOR CITY Q n� {{jj��' / /J� W ZIP /� 2,03 D -I & _ 16 WA STATE CONTRACTOR'S LICENSE N i .o�S l 3 4, 07- EXXPIRATION DATE FEDERAL WAY BUSINESS LICENSE R - s -vo_ NAME PHONE MAILING ADDRESS E -MAIL APPLICANT CITY STATE ZIP FAX PROJECT CONTACT (The individual to receive and respond to all correspondence concerning this application) NAME "e i>eeY! PHONE ' / �( c� 25 '2�1 " z�� p MAILING ADDRESS / '^ �- E -MAIL CITY STATE. ZIP FAX ALTE NA E ONTAGT V�i E:n e ►� LIr P5-3E e PROJECT FINANCING NAME ❑ OWNER- FINANCED Required value of $5,000 or more (RCW 19.27.095 ) MAILING 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 a part of this application. SIGNATURE: ]ice DATE PRINT NAME: TE-ii Q %) 15i � Bulletin # 100 - April 14, 2010 Pagel of 3 k:\Ilandouts\Pennit Application ':d �L r-e ,