97-104464 97-10 1/ 6 y
(CITY OF FEDERAL WAY FIRE PROTECTION SYSTEM PERMIT PERMIT NO.: FPS97-0068
33530 First Way South FIRE DEPARTMENT INSPECTION - 253-946-7318 ISSUED: 12/19/97
Federal Way, WA 98003 BY: FC2
253-661-4000
SITE ADDRESS: 32018 23RD AVE S
PARCEL NO.: 162104®9028
!PROJECT DESCRIPTION: RELOCATE AND ADD SPRINKLER AS REQUIRED FOR TI
r= OWNER CONTRACTOR LENDER
UW PHYSICIANS NETWORK FIRE SYSTEMS WEST
2505 S 320TH ST, SUITE 110 219 FRONTAGE RD NORTH B
FEDERAL WAY WA 98003 PACIFIC WA 98047
.584-8408833-1248
FIRESWI140B1
-
SPRINKLERS? •Y HOOD & DUCT'S •? FEES:
# ZONES • 0 OTHER.,...• SPRINKLER FEE * $ 135.00
FIRE ALARM SYSTEM?.:? EXTENT OF WORK...:? FPS PRMT ISSUANCE. $ 20.00
# ZONES • 0
STANDPIPE? ?
UG FIRE SERVICE'S '
FIXED SYSTEM? ?
TOTAL FEES $ 155.00
INSPECTION RECORD
c7.7-(1%foi 5 c:5-p _114‹(_(-i..e_ c-6-7- o-K, --(-c_-) c_s--2,c) E-C_. ' 41.41
4
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET.
OWNER OR AGENT / DATE i2 t f ( 7
f ps_prmt 07/01/92
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Cal OF City of Federal Way
� FrY�- _ APPLICATION FOR BUIL p PERMIT
III CITY OFFEDERAL wqy
BUILDING DEPT,
PLEASE PRINT APPLICATION #: 1 ,1 'ØG
SITE LOCATION Address azo I$ 23 IZb A- E 5
Tenant (if known) Lot # As essor's Tax #
l�� rk-��S _ t4E7-V,I0 g- l�zl o �0 4c6
Building Owner Name Address
City I State Zip Phone
Nature of Work IZELp CA.TE" / At7/, Sfia/Atoe_e- g_S ,5Qto. Fe 12- T,1 .
APPLICANT1
Name (F,M,L)
F R 5YS-1--Ems v..i c.; VAwE = ° 12-, 000
AddressZ i t F-� t!�A4 il `
City PACI F-( C_ !`� State WA . Zip C\tb e 1
Contact Person Day Phone Other Phone Fax
JA416S 1 /A S 33-12-41S `715 1 1 '3
A-v�CONTRACTOR {� /�G - _,�„p, �
r
BUILDING�mpany Name S�_L_EcriC,O S l.`PL \ C )
Address
ill
VL-'-t6\1
City �'� r1_� ` �� State Zip
Contact Person / Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
l ARCI ITECT
Name
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
' sem
!�/� / iii-I��r�2�►.
I( z( off- '-9 )Z
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Please Complete Reverse Side
CD0492(Rev 4/93)
STRUCTURE feting Use •oposed Use
Permit includes: 0 Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential 0 New ❑ Remodel ❑ Number of Units ❑ Deck
❑ Commercial 0 Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor , sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
"-
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availability ❑ Sewer Availability 0 On-Site Septic System Availability ❑ Project Valuation $
Zoning Lot Size Existing Bldg Valuation $
LENDER
Name Address
City State kip
MECHANICAL CONTRACTOR
Contractor Name Address
F S (.5r g)N1�LCs
City
State Zip
Contact Phone Fax
i'✓1 ES P--(44 RK-- (x-53)63 3--12�f-g —i 3 S--Co 1 i 3
License #' '�I g_e-`C> 1 1.44.;, IS Expiration Date sill!co Verified ❑ Yes ❑ No
PLUMBING CONTRACTOR
Contractor Name Address
City
State Zip III
Contact Phone Fax
License # Expiration Date Verified ❑ Yes 0 No
PLUMBING FIXTURE COUNT
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
MECHANICAL UNIT COUNT MECHANICAL VALUATION ONLY $
Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers _ Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons Total.Unit Count
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 o•
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 Federal 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. C
Owner/Agent: � — N Date: /2 X11
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