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PERMIT K FP-59b-00 FA
Job Address:
Owner:
720 S• 348', sr-
IStreetl (City)
Tenant Name:
IStete) (Zip) ISuite N)
Contractor: - Axi gcu2l ry 5 -,-F Tax Parcel # '?0-04 '11 3Z -33 Z'Z(c 36
Address: 6,3
Phone: &w-3" - ISFi'r Contractor License #:Ar-1 lLmCzo-413-cw Expiration Date: Z It 47
IC&rd must be presented)
Owner's Address:
Phone:
Contact Person: )A,,"ifs FDSS6rr Phone: goo- 3574— lSSS
PLEASE SUBMIT THREE 13) 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:
MAXIMUM PLAN SIZE = 24" X 36"
1 CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE
WORK FOR WHICH PERMIT APPLICATION 1S MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS
TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS' FEES INCURRED IN INVESTIGATION AND DEFENSE OF
SUCH CLAIMS, WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED, AND FILED AGAINST THE CITY OF
FEDERAL WAY, 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 TO THE CITY AS A PART OF THIS APPLICATION.
Owner/Agent:
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted
at all fire alarm installations.
t- / e
1J Deceived
Route to: Fire Department
Approved by:
Date: Z
Office Use Only (Please do not write below this line/
Permit- Fee (Includes First Zone) $30.00
Additional Zonas @ sio.o0 ea. 3o-ya
?t-WvJ�q V ,OD
Total Fees $ 90,60
Date:
CD0491