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12-105000
f � • Ift_: - I ® S ® off arrwA deraiwalECEIVED ,PERMIT SF MF CO ME PI, DE EN ,i1110 COMMUNITY�; t 01 nAPPLICATION APP ,1 wfdewm , ,EEDEWAYRAL Li`- 770 WIN Maawa>wCTCV OF s CDS swrrs/UNIT• $ 5,30© cip (0 ca LI - 01 E- o TYPE OF PERMIT 0IN 0 PLUMBING 0 ICDAMICAL 0 DZMOLI ION 0 121GINIZIRING KM=PRS NAME OF PROJZCT (lenaniName/HomeowrterLast Name) I�QIci?lewooc� 'WO- d E-e 1t .be Makers -'Powt,l1 PROJECT DESCRWflON 1 ck Awl:Iril1ls 1 _ i/N SUxe lt6 . AAA 1er.SuJ ' i Detailed description of work to be included on this permit only Man ram/aaY mon rR,oPBxnr 011111112 CAANIAMV1ilc1 lie.S IVIPn Co r0 0- mums ADINiasspint Ailec4t t�Ff4 Rci. M„`Mad1 sun yJ TV $377()I NA= MINIX I� VI CSAM,c��D(� Al4 an A1C CONTRACTOR MAILING In S- .3, vsa(‘ arrr ec1-E14 Un nP Clif I yy TAX erne YYAS ONTNACTOWS A 6` '7_l�3 1 c n00 DTION OATS IMOINNAL .10 w .51. mut , IM fit ',,.Si nc�ko(1 Nert(�:W.-. APPLICANT 'us i Seo' ' '``S. cKSo �`? . 0- dMP',1cnT 12 7gi W-61, L1-1 FAX PROJRCT CT POOPS `(The individual to�ive and MCA tCT1 Wan respond to all correspondence 1,-MON, concerning this application) Imaa 3 V & �k • eGi+le, 73k >a Icy FAX 411111MIZIO4‘ hir" Drrlolt-3N moJ=CT FINANCING sera 0 oaa7tax-raIAMID Required value ofor more MAI Mie1I US.CITY.stns.of (RCW 19..27.09517.005) !!10lIY I awrtLJ,under penalty Cfperjury that I am the property owner or authorised sant of the property owwr.1 cert(ly that to the best of my knowledge,the Wiernation submitted in of this permitad true d comet.I c rtlA,that I will cel with all applicable City of Federal wap regulations pertainby to the work authorised by the issuance of a permit.I understand that the removeissuance of this permit does not remove the owner•, responsibility Pr ce mpalance with lead, stole, or federal laws regulatbtg construction er enoironasental laws. :further agree to hold harmless the City of feederal way as to ang claim(including costs,expenses.and attorney.fees incurred in the ire salad n and defame of such Mahal,which may be wade by aay person,including the rmdersigned,and./lied against the city. but enty where such claim arises out of the reliance of the cit, including its officers and employees. upon the accuracy of the Winnation supplied to the city as a pert� of this application. li U►TINUI: /0p!i!2 6 ilii.421 OATS //- 1-C20/2n PRINT PNANZ: 1111 C.rk JU1L21t,JG n Bulletin 5100-January 1,2011 Page 1 of 3 k:Wandouts\Pennit Application