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10-102664
deral flay C0:4LW1,NITY DEVELOPMENT SERVICES 25.3-835-2607- FAX 253-835-2609 SPERMIT APPLICATION kt-.CEq\1Y5 EN,(D JUL 01 2010 SITE ADDRESS CITY OF FE)MALITWAT -7t) I _S _-3 -F 0,Ary cbs PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # qO -7 q1 DDO 0-0, 1 1 -7 a -1 a - _a e ��-. TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 1P� 0 DEMOLITION 0 ENGINEERING XFIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) OW2, PROJECT DESCRIPTION Detailed description ofwork to be included on this permit only PROPERTY OWNER NAME Dli&, PRIMARY PHONE MAILING ADDRESS 7D 1 � �2,Q+tl 'S -IF, E-MAIL CITY STATE NAME PHONE 3100 - MAILING ADDRESS E-MAIL CONTRACTOR CITT C-)L-Ym P STATE ZIP 9 FAX &L" vV WA STATE CONTRACTOR'S LICENSE # HOZ - EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # NAME '- 1-0 e7 PHONE 206� 35(z, -7 MAILING ADDRESS 2©Z 1 qqtll 14v-- Al -C 5411 7Z-7 E -HAIL J �OCAOIJ k6' 12- VA ,q APPLICANT CITY uxvow U 0 L(_ STATE 22- ZIP q FAX PROJECT CONTACT individual NAME c,67A p NE (The to receive and DRESS 4DC' respond to all correspondenceKATW E-MAIL concerning this application) L,77brianmA S4 om-L, tAJ STATE. IALA FA I r-AVCC 80-461 ALTERNATE CONTACT NAME. PHONE E -HAIL PROJECT FINANCING NAM ❑ OWNER -FINANCED Required value of $5, 000 or more�NVl� MAILING ADDRESS, CITY, STATE, Zip -ZD()Z S ASL-wt�bn4,3 PHONE (RCW 19.27.095) I certify under penalty o .71 ul--j I -lel t) (_)00515� of that I am the property owner or �rized 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. r 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. rfurther 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 appart Athis application. SIGNATURE: — --DATE PRINT NAME: Z ire= Bulletin #100— April 14, 2010 Page 1 of 3 k:\Handouts\Perrnit Application