00-100111 cnv c • BUILDING DIVISION
• EO 33530 First Way South
Ry Federal Way,WA 98003
V Y (253)661-4000
Fax(253)661-4129
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number:
AWNi 10t) -
PARCEL# �lO q 9C)
Commercial B' Residential 0
SITE LOCATION �/ j
Tenant/Owner �/2/7 J 1/l C fie v l`,�ONAe Ssa'g 1 :J c /7 G to / Phone
Address/City/State/Zip 3 57 tet/ ",t Sig 0741 A / , de / G'i.� y &/i/. Ire Qf
�i f // �?t- /�/uRrr Cin
Nature of Work Project Valuation: $
APPLICANT
Name G! /'/V_ /f c t C /tit C,
Address/City/St/Zip 17/C 7— /.;-7-1 /1-0.€ JQt J 4
Contact Person /Lc 1f //ei Phone alr 2 -6I`/-7/1/ Fax,25.j
CONTRACTOR
Company Name /~ ���/eX
/6 6r 36 f/slg /� I- ' " 7-' / t ' 7s`-- ,�f/G, '41 /14;71
Address/City/St/Zip �t Ott t G C J(Jf I
Contact Person Phone '/2f '7 7e5o Fax 72r f2 7 4-/
State L&I Contractor Registration# 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.
Rcaz6.2....,
Owner/Agent "y;t,t,y,, ✓' Date ///06
'�J
FPS.AN'
REVISED 5/19/99