13-101165 lik
• •
sere.A RECEIVED PERMIT APPLICATION
Federal Way
MAR 132013
Ptaasrr Wawa 19 - tbcttill!
TARIM`tams
ins Atlas IUITWIUIIT a
339 IS ',1--sr Vag{ J, 203
PROMO!VALUATION Zoasls Atm'/TAX/PARCRI.a
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ENGINEERING leg;PREVENTION
NAME OF PROJECT AAMaeleci$k11 , C - Stith. f l
PROJECT DESCRIPTION Fail 11f)�Flc=LeA,An °�ot�e Q23. Add m b Z.
Detailed description of work to PS ba.♦ 1z{C,NI7l�- (0 &5 SkIM13 S A'KE..ole'GC..th'Dr c
be included on this permit only
PROPERIT OWNER Ukli6t MIA UCet ...n4eskrnen 4 (-Orr
Asslwos T ��•
FAUN
Set O N11mA- .l PO n
` `T�' ,1%Stir\ I� _P $c3`70 I
SAtfS\las ki(1l-hnn A tk rm 11 c. •3 --*t9'
CONTRACTOR aARal« -�CJ'�on, S4.CONTRACTOR mrrla6tti'nglESkn� R LE Oft
432C.+tip.. FAXOTTc80-114
w W 1 �.4 a,141-S G3 NI / b— / L3 aowwA10slraRr>�a4
DAMS &,,fy,t2- as CU(1 c vc 6a
T
=NUM A>I•aws /.- niers
APPLICAN
OTT ,,,./-- STATS WP FAX
y
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PROJECT CONTACT nAt� WIC"- OVIL-1A�t,J�pr g `ei e 6 ! �
(The individual to receive and 5^ c ..\c Nit
respond to all correspondence �d S J cJ• tX..G � ��� �',tni�5W11d !k1�(„pr1
concerning this application) �t� c I (1%49
U 1-19 'Wt-3 •�Ja___1 q
PROJECT IINANCIRA IA= 0 thRRstr-Zn1A>1Qt
Required value of$5,000 or more =WNW ABOOXOS,CM,STATS,,UP 55s5$
(RCW 19.27.095)
I certify under penalty.f perjury that I an the property earner or auth.ris.d tweet of the property mews..I certify that te the best
of ay knowledge,the information submitted in support of this permit oppticatien is true and erect.I certify that I will tongs with
all applicable City y Federal Wag regulations pertaining te the work authorised by the issuance of a permit-1 understand that the
issuance of this permit does net remora the owner's rrsgensibtNty for cipmpbanwe with /teal, stat., or federal lows ragulmtMg
construction or enrinnasemintat law.
I farther moot to held harmless the City.f hiders'Way as to any claim(including costo expenses,and attorneys'fess incurred in
the insestlgatia and defense y such claim which nwy be made by any person,including the undersigned,sniffled against the Not,
but may where such Wallin arises eat of the reliance of the city, including its efflcers and employees, aspen the aeenraey of the
Wbrmati.m supplied to the city as a part c tis application.
AT1i11I: °; `%/ r DATE 3-/0-,29/3
PST NA11 f ,rale P1cf lOCVN
Bulletin#100-January 1,2013 Page 1 of 3 k:Vlandouts\Permit Application