00-102358 REG vED IP
CITY OF i., — BUILDING DIVISION
�� 7� 33530 First Way South
1 Fedi*Way,WA 98003
(253)661-4000
Ca BY NDERAL(3 DEPT AY Fax(253)661-4129
FIRE PROTECTION SYSTEM APRLI , I
Federal Way Business License number:
6,g2/6 L( - `t co ( , mosop - /32358--00
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PARCEL # !•),.� 'al pi Residential 0
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Address/City/State/Zip c9te. ----- t e -' �s�* e),..,-.4,:- - P H H. \ .
Nature of Work *.i' / 417,-/i,, /P ' "1 Project Valuation:$ 2 (7C t
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APPLICANT
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Name 4-7CD �ti , . / !4, /
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Address/City/St/Zip S—Ood "'? F-IZf
Contact Person / :t't A/1-= hone - S -79Y7 Fax l l c'?
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CONTRACTOR
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Company Name -
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Address/City/St/Zip
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Contact Person /21_ —Phone Fax
State L&I Contracto In# „4(/ /A« l/`/A /vExp.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 slry 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_
vvOwner/Agent //'/� Date-7, / //y
FPSArr
Rrns®5/19/99