00-100109RECEIVED
6 1 9 - JAN 9-P MjT # UU 109 -- C, G FA
JWTL
IL C i t Y O f F e d e r a l W a y.
FIRE ALARM PERMIT APPLICATION
L
Job Address.
,-Or c--I'
f % (street) (City)
Owner: ( L �C�
L Tenant Name:
Contractor:a /Ali nip►! s )✓I
Tax Parcel #
�_� 9�0z,5-
(stste) IZip) (Suite I)
Address: /'743 / A l o ® -
Phone;_-q2�2 � �! ra'ctor License #: q%ZQ< _�S Expiration Date:
ICod must be Presented) 0, -
Owner's Address:�j iy Phone:
Contact Person: ! �[ �( y Phone:
PLEASE 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:
MAXIMUM PLAN SIZE = 24" X 36"
! CERTIFY CINDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED HY 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 IS 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
S UCH CLAIM), WHICH MAY BE MADE BY ANY PERSON. INCLUDIi?C THE `JNDERSI _ D, AND FILED AGAINST THE CITY'OF
FEDERAl_ WAY, SUT ONLY WHERE SUCH CLAIM ARISES OUT OF THE RE_k
; NCE OF THE CITY, INCLUDING ITS OFFICERS AND
EM,PLOYEcS_U ?ON THE ACCURACY OF THE INFORMATION SUPPLIEZ _ HE CI', ;` AS A PART OF THIS APPLICATION,
Remarks: - - -.._-
Deparin -, n' and Industries
Electrical P`e: , . ,;; be posted
at ail `ir a: lions.
Re::_'._
Route to:
Approved by:
Office Use Only (Please do not writ -
jJes First Zone) $30.00
'ones @ $10.00 ea.
CD0491