03-100759CITY OF
VN� AY
PARCEL #
RECEIVE®
FEB 2 1 2003
CITY OF FEDERAL WAY
FIRE PROTECTION SYSTENr' i PL16%TION
Federal Way Business License number:
SITE LOCATION
Tenant/Owner Q ISS Q
Address/City/State/Zip
RuIIDING DIVISION
33530 First Way South
Federal Way, WA 98003
(253) 6614000
Fax (253) 6614129
F P S_Da - &c)
Commercial ❑ Residential ❑
Phone
Nature of Work—( , k(Project Valuation: $
C r 9 reads ,
APPIrICAANNT(�(�
Name
1
Address/City/S1
Contact Person
CONTRACTOR
Company Name
Address/City/St/Zip
k' U
4 �> `-L')9
mu LF
Contact Person`� t Phone OL Fax 91 -J&J
State L & I Contractor Registration # ��� I� i t�c� �' Exp. Date ' 1 - Lf C_
(Card must be presented)
PLEASE SUBMIT THREE (3) SETS OF DRAWINGS AND CUT SHEETS, PER NFPA STANDARDS.
MAXIMUM PLAN SHEET SIZE: 2411 X 3611
DISCLAIMER: 1 certify, under penalty of perjury, that the information fumished 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 pemut application is made. 1 further agree to save harmless the City of Federal Way as to any claim (mcluding 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 ��� -Ac
FPS APP
REmED 5/19/99
Date It ,), i G
J