03-103353 + 1110 AVE[
4Fic.rryoF pUWIB ZOOS BUILDING DIVISION
• 33530 First Way South
CITY OF FEDERAL WAY Federal Way,WA 98003
BUILDING DEPT. (253)661 4000
• Fax(253)661-4129
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number: ,3 7/
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PARCEL # Commercial Residential El
SITE LOCATION
Tenant/Owner V'l(\ Phone
Address/City/State/Zip 14 e- ) ' i ( f t, 9,1GA)A
Nature of Work Inc t L IA 6r,r Project Valuation:$ g, 700.o
14, c• ai I .. Y'e oc st_4. v‘.00 i cs
APPLICANT
Name 5��' n / 1 z a 'fre l.� -�vic
Address/City/St/Zip E27 v�s) -.)0c1-4'' not-- E, 77,z 1 A t(
Contact Person -7-",,*1,\.- c 4•, Phone Fax
3 r�•La _._ <° Fax `? a ( f-(1)
CONTRACTOR /
Company Name /t.t'ci v'1' + 1 �� x a \c
Address/City/St/Zip t.T.7O' `1 O'4):'
Contact Person '" <<c c C_ Phone O'S---3 �a * -1;1'd 2 0 Fax es('a - Co( ':C1)
State L&I Contractor Registration# ' " ��-�1- �— ' I �^
1� Exp.Date 16 IS /O tI
(Card must be presented)
PLEASE SUBMIT THREE(3)SETS OF DRAWINGS AND CUT SHEETS,PER NFPA STANDARDS.
MAXIMUM PLAN SHEET SIZE: 24"x 36"
DISCLAIMER:['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 wale
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 Federay Way but only where such claim arises out of the reliance of the city,including its officers and em
• information supplied to the city as a part of this application. ployees,upon the accuracy of the
Owner/Agent Ce--4‘7-5 641 / u1c Date E-//004) -
FPS.Ape
Revrsrm 5/19/99