01-101967 rYOF /'� •RacEtVEOgBUILDING DIVISION
\)\> FlYM A 7 2001 33530 First Way South
AY 1 & Federal Way,WA 98003
(253)661-4000
V11 gVILDi-
1N4 DEP7JAY Fax(253)661-4129
•
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number: 3') i 9
FPSO( - /oi% 7
PARCEL# /3,Q,15?6' ` OC 10 -CI I Commercial 0 Residential 0
SITE LOCATION
TetIant/Owner I *C(0 S loae-t_.- sA'r,V (s Phone
II 51 h IIV'' S, it rad t,,"'al 'IS'0 t' 3 n1,,� t l.
p � o0
Nature of Work Via... -c-L,' r- S ItLc Pry L t�nv. �) sir wt 1 ..1W�Q— Project Valuation:$ 3 ( .
dr,�� Ptot)
APPLICANT( nn `
Name Nrxk-r,ni F rr, Nr-nS�c_klo -, Linc .
• Address/City/St/Zip a7 ) 76 0,,v-c- I aZotvv, WA q ettO Y
Contact Person e \ A T• Li v r Phone (2S3 ?a( ad 90 Fax r,7Y-3 -1.),2-(r I SD
CONTRACTOR )�
Company Name dti-,rnt` 1 e t r ����%•Ac k;,„„,_l v'.c ,
Address/City/St/Zip e 7O 7 -76* Vie_ t r.,; A `i 'y t)Y
Contact Person G t r t 061-v r Phone fl2 a,, ' `7r-L -.d co sit' Fax 3 ' d...,- (e 1••=17
State L&I Contractor Registration# PAI"Q-1---_F P 6'l'( e P Exp.Date A)/0,S`/0/
(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:1 certify,under penalty of perjury,that the information furnished by me is true and correct to the best of my knowledge and further that lam 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
0information supplied to the city as a part of this application.
,
Owner/Agent aLtscivi M fr4.12 -+1. -- Date LSi I71 D
FPS.Arr
Revrse 5/19/99