05-1055320
CMY OF
RECEIVED
OCT 2 7 2005
Buu ma DivmoN
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
Fax (253) 6614129
CITY OF FEDERAL WAY
FIRE PR&i 1 %N SYSTEM APPLICATION
Federal Way Business License number: )9} 91 1019S8-00-
PARCEL # L I O�[90� Q
SITE LOCATION
Tenant/Owner
BL
F P S ( _ lG �S32 -vo
Commercial Residential ❑
V S. Phone
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Address/City/State/Zip '1 � , - 1 Bd leyiu e, WA
Nature of Work Zns�,l►U� F; CG S p 0N.V%ter Sus" Project Valuation: 467Dw• 00
APPLICANT (-
Name Fov1 ' A I —IrG "' "' � 1
Address/ 7-1 v` �O � 1T uG(1ti1 G T I W 1 C� 9 Z.9
Clty /St/Zlp 2. GrS acav�c„ W � 1 � i
Contact Person 6�b Faesbe,r Phone Z53. ZB4. 3�e
CONTRACTOR t l Q 1f
Company Name + p CnTf 10I
Address/City/St/Zip
Contact Person � Phone Fax
R
State L & I Contractor Registration # PAT ` I F? U G ! ! CF Exp. Date )01 S 1 ZCDl
(Card must be presented)
PLEASE SUBMIT THREE SETS OF DRAWINGS AND CUT SHEETS, PER NFPA STANDARDS.
MAXIMUM PLAN SHEET SIZE: 24t1 X 36"
DISCL UMEI : I certify, under penalty of perjury, that the information furnished by me is true and correct to the best of my knowledge and finther that I am authorized by the owner ofthe above premises to perform the work
made permit application is made. i further agree to save harmless the Qty of Federal Way as to any claim Cmcludmg costs, expenses, and attomeys' fors incurred in investigation and defense of such claim), which may be
by y person, mcludmg the undersigned, and Bed ap hist1he City of Federay Way but only where such claim arises out of the reliance of the city. including its officers and employees, upon the accuracy of the
nformation supplied to the city as a part of this application.
Owner /Agent � Date I I dGtr 2- Z. TLi)
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FPSAPr
Ravrsm 5/19/99