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11-103485 art PERMIT • •E EN, Federal'Way REC COMMUNITY DEVELOPMENT SERVICES AP P LI CAT I O N 253-835-2607•FAX 253-835-2609 ungui_otuot�r=leralwati f'_ri I�U G 2 6 2 [3; SITE ADDRESS CITY OF FE D E A/WAY 33330 STM !W ENL1 sa- IN CDS PROJECT VALUATION ZONING ASSESSOR'S TAR(PARC�# � O •- © � � O i6,cO G1 22 - - - TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) EDUCATION SERVICE ,Twin 5EtNIEER P.EDUCATION CI LeAt-i CENTER. 57/.f 1Zc -( //9 - .PROJECT DESCRIPTION /N5//9LL.14TICW OF CZ. A( �16FNr AJS112/t3'W1orV-)1))P, N6 . DetaLled description of work to be included on this permit only DE,c<T/cw i e . 5/�6 al ccwrROc 7•'0 ,�Os'rt 2E got) Fog- D_1SCiirR..6k PLrrP rbR.1�1�NITt'R414b By ht�t11wIN6 QST _M NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE ZIP 0W) ARE. P 1 oTEcrioN PHONE"as'6%6501 MAILING ADDRESS E-MAIL /` CONTRACTOR 151=60 kkobIAWILLE-KEI WILD RD NG f7mGpA'1/Cdc sc, (re.CQN'I CITY _OOO/NV1 TATE ZIP `o7L FAX // WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# ccA PPgs MS 7 z 13 ego N r Dy NAME WS- 8C0-103y APPLICANT MAILING ADDRESS +soon IbDDw tIL E--e.e .40up eD NF hrr�oocy@ oscoc'l,%t.covl� CITY STATE ZIP FAX W DoDi N Vi t.t� kfi9 9 5072 • PROJECT CONTACT NAME PHONE (The individual to receive and KEN GLS respond tnall ticorrespondence MAILING COO WCU)I1AV1uE_RE-DMOND K NE /CZD�-$ENRe )SCOME.COM- CITY STATE ZIP FAX - - - - t./OCD 1 NV IL ALTERNATE CONTACT NAME: PHONE E-MAIL • PROJECT FINANCING NAM 0 OWNER-FINANCED Required value of$5,000 or more (ROW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP - PHONE I certify under penalty of perjury that I ant 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, oP 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 theundersigned,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 cit as a part of this application. SIGNATURE: 7��nn,A�,, DATE 'Z• 2.0 I/ PRINT NAME: 132A,Ni I N MCO Bulletin#100-January 1,2011 Page 1 of 3 k: andouts\Permit Application .