00-103375 I RE CE "7rill
CITY OF(.. ' F4E V E I V E D BUILDING DIVISION
• �� 33530 First Way South
SUN 1 4 Federal Way,WA 98003
N.WRy ���] 2000 (253)661-4000
CITY NFE AL WHY Fax(253)661-4129
CI(Y
FIRE PROTECTION SYSertM APPLICATION
Federal Way Business License number( ? Sy� 4 33' 7
? 7 e
fP-S' -
PARCEL# 32 2-i ' — qO q 1 Commercial 3E- Residential ❑
SITE LOCATION
Tenant/Owner J r j v f A/Ie y 41O IA l erso r S c./LA;.% Phone 23-3 67 - &D )3
Address/City/State/Zip 37 A S '
Nature of Work �h'^ (LOCA" Sy/'/> / I!n' '/x) Project Valuation: $ ?.0 V 0
•
APPLICANT
Name S i_(v• LA „,..4,0,...-.4-i'0,5 c.
Address/City/St/Zip P. O r a-0 .-q...3 U /A; i4— j w A9635 1
Contact Person (V\()< /(/vac' Phone a-S 3 53 g- 5-1 q Fax 075-7" 6974-6esi2-
) �.. (.,,,ra"
CONTRACTOR
�.
Company0,A) L it
Name S GA— Lp`I'1`'�'t-(` ....f c v,
V\ , w`n
Address/City/St/Zip v c D. Q o 1. - :?C) � �t I•/ / t/d' ef 6 I
Contact Person M Xe 14.4.1\( aK"1 Phone Fax 83 g- 9S-9g Fax 253 6'7 - 68--q<
State L&I Contractor Registration# S (A-k i ti 1 * 0/I Z-- S
Exp.Date (0)4,20u
(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
tik.6� A�AL Date /Se-)O 0
5PS.APP
NIS®5/19/99