05-106375R
,� 0 RECEIVED
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CITY or G BUILDING DMSION
33530 Fust Way South
` . \> FM' Fe
2 Q Q Federal Way,WA 98003
Tr (253)661-4000
CITY OF FEDERAL WAS Fax(253)661-4129
BUILDING DEPT.
.. FIRE PROTECTION SYSTEM APPLICATION .
Federal Way Business License number: 19-/0 '.57 -00 --gc.
FPS OS` • , Q
PARCEL# Commercial (9'-- Residential 0
. SITE LOCATION
/1/1641
Tenon owner Pay d6UL ( �p( v ieW c ycic`"mho e
', A.. ess/City/State/Zip iv ,� 609dq. �� �2
3t_ / izn l6 0 )�
Nature of Work 1 F( -1410641ri)Vj' ID 711•i,SV` A16 7)tP Sft?,/-Jaiti Project Valuation:$ -` `
fisc 61/061 4104ttf uI/� 13
APPLICANT
Name pilaf F Sr?irki ri, ? C1 '
Address/City/St/Zip 71160 iftV Avg i4 /f-161 i amlo r Gaff wro2 p
Contact Person tai/, !/ ti Phone 70tf l 0( l'/ Fax r0- d U i 'oyo'
G,a,
CONTRACTOR
Company Name 1%iThjt/ c I%i ��1 rrlL iAC `�
Address/City/St/Zip lid) - 7011- 44 /U)I */1'rQ)--- /40/4%2/a 11-) 7f OJT
ilii-L .6 ( ti- 8l� Fax ( x✓I d�/,1Mo
Contact Person / r r Phone 1�
State L&I Contractor Registration# !n/�V l J r/?bQ Exp.Date /ar` l0-
(Card must be presented
PLEASE SUBMIT THREE(3)SETS OF DRAWINGS AND CUT SHEETS,PER NFPA STANDARDS.
- MAXIMUM PLAN SHEET SIZE: 24"x 36"
perjury,that the information 6mrished by me is true and=sect to the best(gm and firmer that I am auawrimd by the owner of the above premises to perform the work{ DISCLAIMER:I certify,under penalty ofmy d8e
for which permit application is ma.I tether agree to save harmless the(Sty of Federal Way as to any claim(including costs,expenses.and attorneys'free immured in investigation and defense of such claim),which maybe
maw by any person.including the undersigned.and fled against the City o[Fedaay Way but only where such claim arises out of the reliance ofthe city,including its olboas and employees,upon the accuracy ofthe . .
infoamtion supplied to the city at a pater(' ' 'on. ____ _...- ,i,;" -
' ,
;
! /02 / `'
Owner/Agent y Date
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