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PERMIT P16593.-00 4 /4111,
r=Ht L ALARM PERMIT APPLICATION
Job Address: 3/ '' 2 / 2 3 /j2 v,e . S . 9S"C:_)
(street) IC+N) WOW MA (Suite n
Owner: Sr 4 0 Tenant Name: --CrC 0
Contractor: /19-.12.7 e ' 7p Tax Parcel # 092,0 4f 9/76
Address: l // 7 ' C o a A At)off rAtc 0-.... 9 go 02.
C2-0 4) •
J
Phone: 2? - •6, Contractor License #: /9-OrSEs//s'Br� Expiration Date: — `r
z2
ICwd must be presented)
Owner's Address: 22°2 5' 7. . 7 p Ho". ,v/le /9-z #7 (Phone: t02 —2s-7—a 9C2
Contact Person: Phone:
/�o b �•�y J, G..t.Io' c9,06> 2 7 2 --uc,
PLEASE SUBMIT THREE(3) EIS OF FIRE ALARM WIRING DIAGRAMS,DEVICE LOCATION PLANS AND CUT
SHEETS WITH THIS APPUCATION.
INDICATE NUMBER OF ZONES ON PANEL,INCLUDING SPRINKLER ZONES,IF APPUCABLE:
MAXIMUM PLAN SIZE = 24" x 36"
I CERTIFY UNDER PENALTY OF PERJURY THAT THEINFO. ATiON FURNISHEDF131('ME IS TRUE AND CORRECT TO 7HE BEST: :,
OF MY KNOWLEDGE AND FURERTH THAT I AM AUTHORIZED:BY THE OWNER OF THE ABOVE PREMISES TO PEERFORM THE;
WORK FOR WHICH PERMIT APPLICATION IS MAD UR E. FTHER AGREE#O SAVE HARMLESS THE CITY OF FEDERAL'WAY A8
TO ANY CLAIM(INCLUDING COSTS,•EXPENSES,`AND ATTORNEYS'FEES INCURRED IN INVESTIGATION AND D
SUCH CLAIM),WHICH MAY aE MADE BY ANY PERsbN )NCLUDING;THE UNDERSIGNED,AND AGAI
FEDERAL WAY.BUT ONLY WHERE SUCH CLAIM ARISES(OU OP'j HE RELIANCE DF THE CITY,INCLUDING S ICERS AND..s;;
EMPLOYEES.UPON THE ACCURACY;OF THE INFORMATION.SUPPUED TO THE CITY;AS A PART OF TINS APPU� .
Owner/Agent: �9. d j� CITY OF FEDERAL WAY
Date: � �� auILDIN(3 DEPT.
co lJ ease do not write below this lino)
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit Fee(Includes First Zone) 830.00
at all fire alarm installations. Additiopnal Zones @ 810.00 ea. 10•0O
T'4 FPJC 2.044 0
O Received Total Fees 8(0 0.o(7
Route to: Fire Department
Approved by: Date:
C00491
I