13-105278 • S
C,TY OF -41Ik
flrEPEDL4'r
13 ► o 5 2 7-8- Pe
Federal Way
PERMIT APPLICATION NOV 2.5 2013
CITY OF FEDERAL WAY
**Most electrical ermits may be obtained on-line at www.cityo ederalway.cSi *
SITE ADDRESS: -1_2.00 ,tM‘ -z> N‘k SCILee — E1�eRnst. v)A'J) WA-) ��6 ie-
SUITE/UNIT/SPACE# ASSESSOR'S TAX/PARCEL# 1 CURRENT/PROPOSED USE
PROJECT NAME �l1�lt t� I.C�A1�i✓
(Tenant or Homeowner Last Name) '0g.
.1.144\hu-Anc4 V oar A' jr ) FL(l-v A-Ater S'+r 51f
PROJECT DESCRIPTION 1µ4 kt`;w►N-,,
Detailed description of work to
be included on this permit only
(AW,./Ak e/v/. 1 GCJC) GC7
NAME PRIMARY PHONE
PROPERTY OWNER c1.4''—V Litistitit ( ) -
MAILING ADDRESS E-MAIL
224 ) S. )t W4.1%
s
CITY STATE ZIP FAX
NAME < 4.
PRIMARY PHONE
Lc%,.) 6`4S1- fS, .L, i C. t, ( ' Z ) q4$ 46gW
MAILING ADDRESS E-MAIL
ELECTRICAL Cont*low vc14.54- 5yS14-644 cc. i-
CONTRACTOR CITY STATE ZIP FAX
Mau-•CiZZI & q'S 01 Z ('ZS) -cm(- 17-4o
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Lota4 Sc‘ g 0% / /
NAME PRIMARY PHONE
)410 APPLICANT r_La E-A-AA Tye (v..iT} Ci 46-- (O`lam
MAILING ADDRESS E-MAIL
\-)6424Y 1LaLc t,.I�l(�Ios,,."o11,ur54r)64y5. c.c�"'1
CITY STATE ZIP FAX J
Asst i.c ra-67E tC— a,vk 4 CtdcS (Lit c)
NAME PRIMARY PHONE
PROJECT CONTACT Co��tatt_ 41/416-lvtAS
(tiz7) 5-or- qaSi
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. �
SIGNATURE: DATE I 1 7)5I ^7
PRINT NAME: ��1 0e44.^^ 1 ,
33325 8i'Avenue South♦Federal Way♦WA♦98003-6325♦253-835-2607♦fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160-January 1,2011 Page 1 of 2 k:AHandouts\Electrical Permit Application