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FIRE ALARM PERMIT APPLICATION
At
Job Address: ! ez i.% --5,r ll, )ewl 4.)A Y �.,J4
(street) (City) f (state) (tip) (Suite 10
Owner: X7✓c e Zo -F /nJ e-4-, Am Tenant Name:
Contractor: L `l -,,;i erect' Tax Parcel #
Phone: ,,7i,G — 57s' —3�-3 7 Contractor License #: ,l (� l dt1 S 11� Expiration Date:
(Card mud be presented)
Owner's Address:
Phone:
Contact Person:05 Paw Phone: +
z-
PLEASE SUBMIT THREE SETS OF Fm ALARM WIRING DIAGRAMS, DEVICE iJ xATION PLANS,
AND CUT SHEETS WITH THIS APPuCAnom
INDICATE NUMBER OF ZONES ON PANEL, INCLUDING SPRINKLER ZONES, IF APPLICABLE:
MAxEmw PLAN SIZE = 24" x 36"
I 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 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 such claim),
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: Date :�UG
Office Use Only (Please do not write below this line)
Remarks:
City of Federal Way Electrical
Permit shall be posted at all
fire alarm installations.
❑ Received
Route to: Fire Department
-) - -
Approved by: � r
FaeALPM Aee
t:Ew®lvuroe
Permit Fee (Includes First Zone) $30.00
_ Additional Zones @ $10.00 ea
Processing fee $20.00
Total Fees $
Date: 16 .&-)