00-100040 CF,'OF 4111=. BUILDING DIVISION
• F 33530 First Way South
"" Federal Way,WA 98003
�/k)~ (253)661-4000
Fax(253)661-4129
2,0
JAN ® 5
t'1t„g0 DNGOEPI I EdPROTWay BCTeralION61-4usiness License 000 APPLICATION
4665 Fla-S_Z"*Ittlda. FP
PARCEL# Commercial 0 Residential 0
SITE LOCATION
0 Tenant/OwnerItirij �ivit.)�`� ��'" �) Phone
Address/City/State/Zip -------"03-73-: /9-67`l C--'" ///14)
Nature of Work / �� /L7,-e. �C)iG1,G `eM---) Project Valuation:$ / t9J—
�
i/19 /r/t} e
APPLICANT
Name
Address/City/St/Zip
Contact Person Phone Fax
CONTRACTOR
Company Name 6
Address/City/St/Zip 6l r0 1 ..5-0 " '� i/t4= -c)(
Contact Person ,,� /-/9-7,—,..4 ,47'
-,..4 ,4Phone 2- "' 72'4 01 D Fax �-U(`' '7' 7 .Z°./7
State L&I Contractor Registration# / 772'P*(e) C L Exp.Date -/-p0
(Card must be presented)
PLEASE SUBMIT THREE(3)SETS OF DRAWINGS AND CUT SHEETS,PER NFPA STANDARDS.
MAXIMUM PLAN SHEET SIZE: 24" X 36"
DISCLAIMER:I certify,under penalty of perjury,that the information furnished by me is true and correct to the best of my knowledge and further that I am authorized by the owner of the above premises to perform the work
for which permit applicatimade.I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in investigation and defense of such claim),which may be
made by any person,inchidin the undersigned,and filed against the gf Fedemy Way 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 e 'orCas a part of this application. (7 „- J
Owner/Agent ail Date
FPS.Arr ,i•
Raves®5/19/99