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BUILDING DIVISION
n 33530 First Way South
RY Federal Way,WA 98003
RECEIVED BY (253)661-4000
MMMUNlTYDEVELOPMENT DEPARTMENT Fax(253)661-4129
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number: /
FPScfq - 'r�4,�7p
PARCEL # Commercial 0 Residential 0
SITE LOCATION
Tenant/Owner � S 1 i 11 1/0 Phone
Address/City/State/Zip .3L1 3 L S 44-h W4y kJ!} 4'8003
Nature of Work ie.� 4),4A/�/ SV,$TE/1 /111)/ ODA/ Project Valuation: $ (i Z
r/ •
APPLICANT •
Names Pi n//VP f-1/E: es-/P/4A/V
Address/City/St/Zip / 7 /S (le..-TA/12/9-e • Su/7E // !% WO-5-4
Contact Person--i1( Phon 's98 cQ-25666. Fax FiLq-5 L-66-
CONTRACTOR �
Company Name C�,i7-.M./A/617?-4.. f`/2 /9/42/-16Y 4 ( b/4°4NY
Address/City/St/Zip /1/�� l'.�l j P& 'A-L /4W- S• SC//7� /L �' 'vT Q8o 2_
Contact Person I1)-1z Phone (z' 985Q'-5UPIP Fax ''';)6Y---5 Z5-6
State L&I Contractor Registration# 72( ( 21AI/LC126( S7 Exp.Date /Z. " OO
(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: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 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
information supplied to the city as a part of this application.
;r 7 yt 49.
Owner/Agent -C1 Date
FPS.APP
Reviser 5/19/99