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•
FIRE wLHKlvi PERMIT APPLICATION
SEP 2 31994
Job Address: 20 3 ` '11 G • fCJeRt- l. l lAqA. CITY OF FEDEp�RApL AY
(Strait) (Cur) (St t.) ISWI,UINU 15
Owner: Tenant Name: �ei C.)(' W 4 '`st41 a-
Contractor: Sc EJE yvlAQvA.C.\4 Et,EeT QA lSrn E INC. Tax Parcel #
Address: qal (Zt tNG2 I'-Ev-E So .3ea.4-Qu. LtAA. g8I41
Phone: Sa ct-aO(4O Contractor License #: ORI 118 Expiration Date:
(Clod mint be presented) •
Owner's Address: Phone:
Contact Person: Phone:
vilLEASE SUBMIT THREE(3)SETS OF FIRE ALARM WIRING DIAGRAMS,DEVICE LOCATION PLANS AND CUT
SHEETS WITH THIS APPLICATION.
INDICATE NUMBER OF ZONES ON PANEL,INCLUDING SPRINKLER ZONES, IF APPLICABLE: e
MAXIMUM PLAN SIZE = 24" x 36"
CERTIFY UNDFR,PENALTI(O PERJURYTHAT THE INFOR.410:O 4;70!0EDt.s H ME IS TRUE ANI�`CORRECT TO TH i
E"PMFrt.3
OF MY KNOWLEDGE AND FURTHER'TKATI AM AUTHORIZED BY THE OWNER OF AB THE OVE PREMISES TO PERFORM THE f
WORK FOR WHICH PERMIT APPUCATIOI IS MADE, I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WA1f AS
TO ANY CLAIM(INCLUDING COSTS EXPENSES,AND ATTORNEYS'FEES INCURRED IN INVESTIGATION AND DEFENSE OF i
SUCH CLAIM);WHICH MAY MADE BY ANY PERSON INCLUDING'TfHE UNDERSIGNED,AND FILED AGAINST'THE.CITY 00010
FEDERAL WAY.BUT'ONLY WHERE SUCH CLAIM ARISES OUT<OF ThE RELIANCE OF THE CITY.INCLUDING ITS OFFICERS AND '':
EMPLOYEES,UPON SHE ACCURACY OF E:INFORMATION SUPPLIED'TO THE CITY AS A PART OF THIS APPLICATION, r m
Owner/Agent: 1 Date: 2-30 44
Oh9cs not writs below this I nsi
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit•Fee(Includes First Zone) $30.00
at all fire alarm installations. _Additional Zones 0 $10.00 ea.
❑ Received Total Fees g
Route to: Fire Department
Approved by: Date:
C00491
1