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16-104301 , cath Kilt Fire & Rescue :. v .. 77O1\%) ,.: �s Detai:ed ;s CITY OF 311111ubject to attached detail, Federal 1r _.__.w,.....__..._ _.PERMIT APPLICATION rr7,„.._ ___,Olt__prmalrittimBER / 6 — ...4.12.(1_ 3 o I _ EP SUITE/UNIT/SPACE if SITE ADDRESS: ',0(a\\ s (,,,..i.\,, t\e_ PROJECT VALUATION ASSESSOR'S TAX/PARCEL ft CURRENT/PROPOSED USE $ .17124-r O g `'). 1 r 4 - © 0 l PROJECT NAME (Tenant or Homeowner Last Name) Q„r �\ tt.) S PROJECT DESCRIPTION "rt" 1'"r..— \jS Detailed description of work to0,r, '1„e„..\\� ,..\-,1.01,,, „r �ie,�i'"„\ P,tr....-.�. . be included on this permit only ,,((�� ``J ikg i 0 43 , �(a•d a �zc.e..a, -\-7:,,,,e_ z;,i. Fr 00 S'.i..r a, NAME y( \SPRIMARY PHONE PROPERTY OWNER P/'4-\ ' QJ b`\C... ;c. `S ( ) - MAILING ADDRESS E-MAIL 33330 e) Z S CITY STATE I ZIP .FAX . . cre-c\i2,0 .-\ VAby A q'6O0'2 ( ) - / PRIMARY PHONE MAILING ADDRESS , --oo E.E-MAIL ELECTRICAL e1\ h) i(�d f W t y ..mit-\--0,...1 c.,.e_s e`c'i r.4. CONTRACTOR CITY ✓ STATE ZIP FAX ( j cc 1p^ VIA 'ta4-o3 ( t'''fl 3 -,a 44 6 WA STATE CONTRACTOR'S I ICENSE t EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE it '6,4et-a.k 0(j S X31 /k6 NAME PRIMARY PHONE S G'----C. bre 0 J e_.. ( ) APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ' NAME ( 1 PRIMARY PHONE PROJECT CONTACT KVA., (,__;z ( 6%) tri - 4-5041 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 costa,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 supp ied t the city as a part of this application. i SIGNATURE: p DATE 1\` ‘� �B' PRINT NAME: kAC` (.coA4`s✓' PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607+FAX 253-835-2609+perrnitcenter@cityoffederalway.com Bulletin#160—April 14,2016 Page 1 of I k:\Handouts\Electrical Permit Application