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13-102319 ECEIVED mor MAY 2 8 2013 ELECTRICAL CITY OF Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION CDS PERMIT NUMBER / 3 _ / 2 3 / ' _ �/l SUITE/UNIT/SPACE# SITE ADDRESS: :;3325" e6. Q vt, , PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE $ 00 0 - - - - PROJEC'i NAME /' (Tenant or Homeowner Last Name) C PROJECT DESCRIPTION °�11"0/\' 01 AA 4S,c WA %A-5-r [l Detailed description of work to be included on this permit only NAMEPRIMARY PHONE PROPERTY OWNER 7," F-20 ) - MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ) NAME PRIMARY PHONE Cry (5 ) >$L - 270 MAILING ADDRESS E-MAIL te ELECTRICAL 33 lam' ' �f 41-e.,1,1 (-2'Yi. (P CONTRACTOR CITY STATE ZIP FAX ,c) _\ MA or7.L t ) - WA STATE CONTRACTOR'S LI NSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# L.47r1141,1 Or !Ai NAME PRIMARY PHONE ( ) APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ) NAME PRIMARY PHONE PROJECT CONTACT ( ) 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 the city as a part of this application. SIGNATURE: DATE 5/13/'," (," PRINT NAME: Bulletin#160—January 1,2013 Page 1 of 2 k:\f{andouts\Electrical Permit Application