09-1022799- �d2 z ;Z2l
�moF C E I V ERMIT SF MF CO ME EL PL DE EN.
Federal
commugyD a 1 s zcAPPLICATION
253 - 835.2607• FAR 253 835 -
www.cituoffedero1wou. com
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SITE ADDRI CD
SUITE /UN I1 #
ZONING
ASSESSOR'S TAX/PARCEL #
Ra:�c
NAME OF PROJECT
�p
(tenant or Romeoumer Name) ►
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
Q DEMOLITION ❑ELECTRICAL Q ENGINEERING FIRE PREVENTION
AtArum J G S
'
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
c ) -
MATTING Aunims. CITY. STATE. ZIP
Z-KAEL
OWNER IS ALSO:
COWMACTOR APPLICANT PROTECT CONTACT
NA�
t?RCJ� -CG f me AQ to(-,
PRIMARY PHONE
(2, ) 9s7- C9t 7
MAKING AUMMEW CAM, STATE, ZIP /� ��
OT Iq Jr �'ri1/1!T
/FAX / /�
(zv (0) -LIP - M, 0
CONTRACTO
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY MSHU 88 LICENSE #
F4C I L—L-52 7 3 10 0
10 /�o X09
26-06° - )03 -00-
NAME
` 1 l ►J�.
PRIMARY PHONE
c U(P) q`� 7- O 90 ` 7
APPLICANT
Imo.-- t 1, Ml i� K- n.if
MAH.tNG ADDRESS. MT, STATE, ZIP
PvPtAtt Xftf
FAX
cam) .7ZO - &J60
PROJECT CONTACT
'�"a i
EAS —M
rz ) � pia y9
,The a and
(M 1 l4
MAnmo ADDRESS. CITY, sTATE, ZTP �j ''"
�0
FAX�i
1 (00
respond to all correspondence
this
concerning application)
t Ag � t '7
W(o ) 714 - O
TERNATE CONTACT NAME:
7
PRIMARY PHONE
tvo
E-MAIL
'me,
)sic 77707
P pfS. a�
PROJECT FINANCING
NAB
❑ OWITER- FINANCED
Required for projects with
MMUM AMIUM, cny STATE, M7
PRDdARY PHONE
uaakw of $5,000 or more
(RCW 19.27.095)
I cerWy under penalty of perjury that I am the property owner or authorised agent of the property owner. I certjjy that to the
best of my knowledge, the tojbrmation submitted in support of this permit application is true and correct. I certvg that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that
the issuance of this permit does not the owner's responsibility for compliance with local, state or federal laws regulating
construction or environmental laws.
I further agree to hold harm City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred
In the investigation and qf, claiml uNdch may be made bg any person, including the undersigned, and filed against the
city, but only w out the reliance of the city, including its q$ieers and employees, upon the accuracy of the
information red of application.
-o9
SIGMA DATE
PRINT NAME.
Bulletin #100 - 4/21/2009 Page i of 4 k:\Handouts\Permit Application
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