00-104117 • •
qtr of BUILDING DIVISION
EO 33530 First Way South
"" FIy Federal Way,WA 98003
(253)661-40
Y�/ AUG 0 1 21 Fax(253)661-4029
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number:
FPS - - /041111171
PARCEL # Commercial 0 Residential 0
SITE LOCATION 5- 1-90 I"""i'
S
Tenant/Owner Ae h e V e (6) e A( JPhone
'213 $S /4-/5—7
Address/City/State/Zip 111-111 P-I . t U SCd i c(G I( ( •A t t.e a o? 617 M z ()til- LA)l1
C a
Nature of Work_(' e (a r ' 7yS`' rn Project Valuation: $ '- O 0 U
/
APPLICANT
Name C keett.7 Q
Address/City/St/Zip
Contact Person g' eit' �44C'(°CVI Phone(e153) qC 7 �`&( Fax
CONTRACTOR p
Company Name ii4 11C, ; Nom' - 44/c roJ Li(- Z iFSS C7-tioa)
h' p
Address/Ci /St/Zi 3 5 7l G6r)-1"1 c ( ckAc't a CA 61 6 61
Contact Person (I tr ` 't C- fej Phone 5-R) 375-- 3 600 Fax
1 Y Y 6 C: 1 4 r i��- 69/ /a/
State L&I Contractor Registration# 1/1-1\) Exp.Date /
(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.
Owner/Agent ,It.,1,711,
`•C'•��y` Date ' r C Z
FPS.APP
REVISED 5/19/99