18-103786 RECEIVED
ELECTRICAL
CITY of A AUG 0 2018
Feder I PERMIT APPLICATION
'' � D CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
AUG 20 2018 PERMIT NUMBER / "`FFF
3 _ I 0 3 7 ' _ L
CITY OF FEDERAL WAY v W
COMMUNITY DEVELOPMENT SUITE/UNIT/SPACE M
SITE ADDRESS: 31 G 4 0 pA-C( G( C u v 5 S L,« TE- A
PROJECT VALUATION > ASSESSOR'S TAX/PARCEL# IL CURRENT/PROPOSED USE
$ ��/ 5-bb b 9 A / 0 I7 - p a. oZ
PROJECT NAME /
(Tenant or Homeowner Last Name) �t e.-�( W Pl a Zoe`- - Swi k A
J
S 6 PE 2A-TE 2_ -re-k 4-07 SP,4CE S , 4-t .D
PROJECT DESCRIPTION 2-06 /1- /1' 11 PA-o c 1 4-1'^ L\ S -Pc i2,4-7-1c--
Detailed description of work to 1,) 671--( Tt (Jiv > Po uJe 2 C/ 2 C. 11—S
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ?tie 51-( (-tG paopeiz -( M4-0A-G7Gc4&1( ) -
MAILING ADDRESS E-MAIL
1 2- 9 13e-(-- j2 Ab `7u l re 2o()
CITY STATE ZIPFAX
D6LLC0ciE ko- q$ DDS ( _ ) --
NAME PRIMARY PHONE
CleeG°te14 eLG T - C (LC (Z ;)33`f- 9 6
MAILING ADDRESS
ELECTRICAL 3LN 20 �� AV e S 9 y eea-1- ke(ec4f►C 6), /n%-h?4n
CONTRACTOR CITY STATE ZIP FAX c.„,'Y
y-Uct 2-0 wA- gg o o / ( ) -
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
<zgeePEL93 Ki
NAME PRIMARY PHOIE
I n
APPLICANT t ee LS re K- C L C C t e 1 - (2c'5) 33(1 - 9
MAILING ADDRESS 1_IE-MAIL
�uq 2C-) S;`' /NE. `7 ,��ena-eK'e(e��✓,L�9il,'lAil .c0,1
CITY STATB. ZIP FAX
AubW(I WA- 1'0o 0 II ( ) -
NAME PRIMARY PHONE r
PROJECT CONTACT L A- b I VVI I 5/-t Erne 2�Kp (23j);;(1 - 9?-6 (
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 o such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where such clai es out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to city a part of this application.
SIGNATURE: c rCk -A 1 DATE U 0 6 /2o /8
PRINT NAME: V L.4 t)I 111 112 �j(�(€ 04 6 Q E KO
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application