00-102823 1
III il
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,Ya •ii 3 r».; !l ED BUILDING DIVISION
33530 First Way South
�n Federal Way,WA 98003
uv f�Y MAY 15 2001) (253)661-4000
Fax(253)661-4129
..i t r tr FELERAL WAS.
FIRE PROTEG D STEM APPLICATION
Federal Way Business License number: 125/ -1,c4a-2
FPS -
PARCEL # 9150 45)005O
51eO5b Commercial EZI Residential 0
SITE LOCATION !�
Tenant/Owner11/dt 4 �J °� "" ����""""" �, `�` � Phone
Address/City/S3�O3' "' S �t"" /��
Nature of Wor �� i1 OA/' P z/� T �e1'• ie Project Valuation:$ ���� OC)
APPLICANT
Name aet
L!94é& W4 /7:d?/.7 / (l,
1
Address/City/St/Zip
2.--; O 1)//(1" tel ` /615.6m .la-&',5'P
rk 4Z7
n g.f ' � Phone(46) -- ' V F7Contact Person - . r � �'3?
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CONTRACTOR �� �,�
Company Name {�'�`0`�-!''rro� *�
Address/City/St/Zip
Contact Person f Phone Fax
P� i
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 fled 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
" Ost(y� zi Date
FPS.APP
Rays®5/19/99