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11-102885
R. EcEINE — 0 01 D I _ 2 ? 5 CITY OF skid/1 8 Za\l PERMIT SF MF CO ME PL DE EN FP Federal Way ay COMMUNITY DEVEIAPMENT 5Q1 rrr►►► cDS ` II'LI CATION 253-835-2607•FAX 253-83 - l.V J www.cituoffederniwau.com SITE ADDRESS SUITE/UNIT# 35(05o - (0 '-11 gave 5 2,--, 0 FLoor $ PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# 150, ( ° C 2 cog o - 0 / f O TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING VFIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) 'TiaA0 -� L(; "�-", •"r o D i PROJECT DESCRIPTION Ll. r * r DD t© e X i,s-'7.i,IL-1 i'I R-G .5 P e-I til i4-t_G IL, Detailed description of work to SY.S T( 1`h be included on this permit only NAME ' PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE ZIP NAME -.. PHONE i4 e,ct-IC 1Z Cok[s rLti G 1 0 0 253...el 2_ "1222 MAILING ADDRESS E-MAIL POel_C,M.1Oo CONTRACTOR 19)5.5 S -2-cte 4-h ,c7". I L H_e C,or y't e u cr i o it.C C'' CITY STATE ZIP FAX K l,_I r t.JA 96032_ 23,,con L 7 til WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# AVCNE1. . 2i 1prz `I / 1 / zoli Zo-oo-)e)q(o3-00-6L NAME PHONE 17C-11 R- Pa(--t5 r4-00 2-53 `612 '12.7_2_ APPLICANT MAILING ADDRESS E-MAIL P2l c-7 pc D -, L -1555 S 2.00 *" 6�- lilt 1ttrrz_C.vtiI-T(z{.icrra,u.Cork? CITY STATE ZIP FAX 1--6:4-1r (.^.'✓9 9969)3 2 PROJECT CONTACT NAME PHONE (The individual to receive and ?e' e. CLC, o D o respond to all correspondence MAILING ADDRESS E-MAIL concerning this application) CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL 12YR/4 ,-coTT PROJECT FINANCING NAME 0 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. /1 SIGNATURE: _�/ 1/1 DATE `7' Jam✓ 'to i PRINT NAME: PG TCR- .-D(..----(—C7/1 P 0 Bulletin#100—April 14,2010 Page 1 of 3 k:\Handouts\Permit Application