03-104841 TYOF • RECEIVE • BUILDING DIVISION
• ED 33530 First Way South
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Y V Ry4 2003 Federal Way,WA 98003
�/ QC� 2 (253)661-4000
Fax(253)661-4129
1TY OF FEDERAL\NMI
0 n'Nr.,DEPT
FIRE PROTECTION �`S'YSTEM APPLICATION
Federal Way Business License number: si311
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FPSO3 - Idi-E 1I- FP
PARCEL# Commercial Residential 0
SITE LOCATION
Tenant/Owner
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Address/City/State/Zip rc LI 1 Or `n i tk &u -, JU L lift(
Nature of Works m(1, 1---e-Y1 fk Vl 4 1, h " Project Valuation: $ 1500, 00
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APPLICqui.aq),
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NT I �7 r^
Name I CmS.P((J(1 1sti C.i ern S r�rX /,4 vt.bL- VY/c 7/t(1/
Address/City/St/Zip 114 3 1 S`4 G-e c , -r6k C a )6 616 r3 H
Contact Person SACO VI aViC au l' Phone 2-CD(Q - 4(0-15.3 ` ax 3L1I qct a
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CONTRACTOR
Company Name,�`,w(:P. aQ (,t0QV. _
Address/City/St/Zip (171`l 5 ( s4 �. 5--m--
ContactPerson� 1Y1/MI ► CA-(A Q Phone Ootiu ao���SxFax -J 1 ) -Ili-2°
State L&I Contractor
VVRegistration# (1()0-�� 33 K Exp.Date Oct /014
(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 maybe
made byt 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
-7) information supplied to the cityas a part of this application.
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Owner/Agent ‘ AAti� )) Date '`
-i
FFS.Apr
REVISED 5/19/99 /6)/
/(15
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