10-103110 v` X19 J6
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CITY P1 RMIT - __. .....Federal Way SF MF CO ME EL PL DE E la
COMMUNITY DEVELOPMENT SERVICES AiPL `çATIoDLed• t=EDER,AL : etailed _
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SITE ADDRESS s
sos 5 . 33loth �,-�- y 6 -
SUITE/UNIT 8 ZONING Date 7 ASSEii SSOR'S TAS/PARC' # O
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NAME OF PROJECT .,� n
(Tenant or Homeowner Name) I^v `Si Cor r t 1. or 1 V. u ��1I r c sp &I 54-41 l�'`�
0 BUILDING 0 PLUMBING 0 MECHANICAL 77
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING /FIRE PREVENTION
MA Cl4) int
PROJECT DESCRIPTION P`er, C3', c�� S
Detailed description of work to
be included on this permit only 13`0:3 (I.\ V'1CaCt , (Cic l/�'�
)/,'? 110- j C.-L
' PRIMARY Imo=
PROPERTY OWNER NAME 'PSP 1'-C.ct ua• t/Cal L j ( i Y---;c4 -I3 G a
MAIUN( ADDRESS.CITY,STATE, a J 6 j 1e„ a df E-MAIL
OWNER IS ALSO: ❑ CONTRACTI 0 APPLICANT 0 PROJECT CONTACT
4 NAME PRIMARY PHONE
(')-Cr- Pcare_ Prot on l kvx c. (�ZST 4/81- 7(o&?
CONTRACTOR MAILING ADDRESS,CITY,STATE.ZIP FAX
cd &x 124\2. rviil1 Greer, 1)3P 2. (ilLS)Mie/ -e(crt-
7 WA STATE CONTRACTOR'S LICENSE# EEPIRATION DATE FEDERAL WAY BUSINESS LICENSE C
C w )cA--)a 4 /S- /11 lel.fevoscpw-oo•,L
NAME PRIMARY PHONE
APPLICANT •Savvte - as eAIoo ve,• ( ) -
MAILING-ADDRESS.CITY.STATE.ZIP FAX
( ) -
PROJECT CONTACT NAME PRIMARY PHONE
�O
(The individual to receive and .i �sS tQk vl O v - ' (RS—)a / -7(G(07
respond to all correspondence MAILING ADDRESS.CITY,STATE,ZIP FAX '
concerning this application) ( ) -
CrALTERNATE CONTACT NAME:
4 PFUMARY PHONE E-MAIL
i le 05icx A ( 71 / 7(o0 ' Jess eco e Cro w»• .Corn
PROJECT FINANCING NAME
❑ n
Required for projects with
value of$5,000 or more MAIL=ADDRESS,CITY,STATE,ZIPTragE,
NE
(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 lams 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 city as a part o this application.
SIGNATURE: ,r///(/. : . .. ' DATE 7 Z/' /O
PRINT NAME: S'ICa. ' I i/!7.c Xl
Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application