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10-105095
4 • n, _ / 0 g-o .7, --- E. CITY OF 4NNM PERMIT SF MF CO ME EL PL DE EN trili Federal Way COMMUNITY DEVELOPMENT SERVICES APPLICATION RECEIVED 253-835-2607•FAX 253-835-2609 www a(uoffederalwau.com ;�, .s" z�, ;,n.r, ..lFi�.RRs.`BAR.. '.!!c"�,�'i;.',:n„:,” ..� .. ;.,102,17,,,,Z, 7,, :}T. ,. . r. SITE ADDRESS 5UI05 a a 3�-m S CITY OF FEDERAL WAY TE/UNIT# ZONING ASSESSOR'S TAX/PARCEL# q 2 & 4- S" 0 _ c@, O. 7--o wi f,?1 'T „ ,.4. 't','t:40A.vf:r �<; fl�'7',A-- ^'4W, Y k«' <?L ;r .,,,,;,.:..,,,:,,,., ,,,,,,:i:,: - { »� ::'+'s ,,. NAME or PROJECT DX-0 c� 1.\` ( ©��J (Tenant or Homeowner Name) 1\ �fin/ ��Is ❑BUILDING 0 PLUMBING 0 MECHANICAL TYPE OF PERMIT 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING/ FIRE PREVENTION MA (S) rcSrin er hctias PROJECT DESCRIPTION Nom. 1 0 / 1 Y,.� w�,`�k- -e� Detailed description of work to `Jt lJrt[ ` iJ 1 Vvearis be included on this permit only ;"'6'4,4*„i!74t.: is ..k;.:` ,'-:: .. '6'R ,..'iA .” 1` `•,`,.)-4:q P,;.• f t.;.. ,,4: 00004A ' r` ,r`' t PRIMARY PHONE PROPERTY OWNER Mnakion i Develop me'1-1- ( ) MAILING ADDRESS.CITY.STATE.ZIPE-MAIL tD lJ foTe - u..bq 4a(5]) ❑ PROJECT CONTACT OWNER IS ALSO: CONTRACTOR 0 APPLICANT PRIMARY PHONE tom rre PceL 4 c 3n,1&C (W487- 710(67 ONTRACTOR DRESS,CITY,STATE,ZIP FAX 44 o 1 l Y \\ C ek` qSc 4 / - et69 -- WA�SSTATTEE CONTRACTOR'S� / LICENSE'# EXPIRAATTION DATE 6.99,49-5-14/.06.82- PRIMARY 'F�FEEDDE�RRAAL WAY BUSINESS LICENSE# J CiK/Y� �V �r 14 /C l '12- r I ! i 29 d,,/ A ). L NAME PRIMARY PHONE APPLICANT —SOjW_, aS C_orrfYIjeto— ( ) - MAILING ADDRESS,CITY.STATE,ZIP FAX ( ) - PROJECT CONTACT /�� ` Lo/ r PRIMARY PHONE G� (The individual to receive and �JC� C-Ok �1 nsn CLOW n (��c)�gl - Ace / respond to all correspondence MAILING ADDRESS.CITY,STATE,ZIP FAX concerning this application) (y2G)I!d) - pl_/.�' ALTERNATE CONTACT NAME: PRIMARY PHONE (i7 Y'OEE-MAIL G`7J ( ) - 155 icaeCroWnfip.COm PROJECT FINANCING NAME 0 OWNER-FINANCED Required for projects with valve of$5,000 or more MAILING ADDRESS.CITY,STATE,ZIP PRIMARY PHONE (RCW 19.27.095) ( ) - 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. Ifurther 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: ^�{y-� DATE 1 1 21p-1D PRINT NAME: OA?111 � / Bulletin#100-January 1,2010 Page 1 of 4 k:\Handouts\Permit Application