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RECEIVED
4U�C �
ER 199 OCT 101995 PERMIT # —
REVIEV�ED UND o oq-c FA
• I, "AL 'Y
City of Federal Way .
• FIRE ALARM PERMIT APPLICATION
Job Address: 33tr),2. ALI t- c L —t UrF‘_at,y D\A� 4.DiQAL
(Street) `^rA1 IAA tOW
•
(City) IStktel (Zip) (Suite,I
Owner: Y e,,\) etc zoiA \tel_ Tenant Name: VI f-) il-na\ZOAlFOld
L—_
Contractor: // ►--k-A
\A,A .(.4.x-- -(177 , ys�fAA S Tax Parcel #
/
Address: /7 �Si /�� J:. I
Phone: c7q6-6ZZ-6S-.S Contractor License #: 6tAki�.06S233 - Expiration Date: 1-3 —��
(Card must be presented)
Owner's Address: 33002__ ge.IFIc I&u / Sot. { /
�� __/ Phone:
Contact Person:
Phone:
PLEASE SUBMIT THREE (3) SETS OF FIRE ALARM WIRING DIAGRAMS, DEVICE LOCATION PLANS AND CUT
SHEETS WITH THIS APPLICATION.
INDICATE NUMBER OF ZONES ON PANEL, INCLUDING SPRINKLER ZONES, IF APPLICABLE:
IIIMAXIMUM PLAN SIZE = 24" x 36"
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 APPUCATION 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,INCLL v:Nr,
THE UNDERSIGNED,AND FILED AGAINST THE CITY OF
FEDERAL WAY, BUT ONLY WHERE SUCH CLAIM ARISES OUT CF THE RELIANCE OF THE CITY, INCLUDING ITS OFFICERS AND
EMPLOYEES. UPON THE ACCURACY OF T E INFORMATION '''.,i,'PLIED TO THE CITY AS A PART OF THIS APPLICATION.
1,.Owner/Agent: i Date: /0' 93
U.ffic (.i ,, -lot write below this line) .....
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit Fee (Includes First Zone) $30.00
at all fire alarm installations. 3 Additional Zones @ $10.00 ea. 30
_i Received is p pe_t
Total Fees $ CO.Co
• Route to: Fire Department
Approved by:
— --- Date: