94-100799 91 00019
CITY OF FEDERAL WAY FIRE PROTECTION SYSTEM PERMIT PERMIT NO.: FPS94-0021
33530 First Way South BUILDING INSPECTION - 6614140 ISSUED: 05/09/94
Federal Way, WA 98003 BY: FC
661-4000
SITE ADDRESS: 1816 S 320TH ST
PARCEL NO.: 092104-.9208
PROJECT DESCRIPTION: FPS = INSTALL FIRE ALARM SYSTEM
- OWNER CONTRACTOR LENDER
OLD COUNTRY BUFFET NATIONAL GUARDIAN SEC SRVC CRP
10260 VIKING DR 3033 - 16TH AVE W
EDEN PRAIRE MN 55344 SEATTLE WA 98119
6946-4763 443-9620
NATIOGS099RW
4110
SPRINKLERS' •7 HOOD & DUCT?.......:? FEES:
# ZONES • 0 OTHER..,..:? FINAL PLAN CHECK...* $ 30.00
FIRE ALARM SYSTEM?.:? EXTENT OF WORK...:? FIRE ALARM FEE * $ 25.00
# ZONES • 0 BUILDING PERMIT * $ 20.00
STANDPIPE? 7
UG FIRE SERVICE? •7
FIXED SYSTEM? •7
TOTAL FEES $ 75.00
INSPECTION RECORD
APPROVED
411 KING CO.FIRE DISTRICT 09
ZZ S
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 / / " 1(Ca 'i .w�. DATE /
fps_prmt 07/01/92 /
PERMIT #
City of Federal W a y
FIRE ALARM PERMIT APPLICATION
Job Address: ( (7 / •S' �o� 3 s ' re -eretl tcJa C(I FO ova
(street) (City) � � Istel (Zip) (Suite#1
•
Owner:( 6 c fri n`„ 9v Tenant Name: £-/(i l Ocru ' Y (./ cal
/IQ
�/ / ��� l U _ ��
Contractor:/ Q!I Jv c* l 6:t cc u/n Tax Parcel # C 7 E
Address:� )141
G33 ( G '5?/-C Q &)4 %/7
Phone:/ Contractor License #: /04106S099/Expiration Date: /.D./l6/g5-..
(Card must be presented)
Owner's Address: Phone:
Contact Person: ALL A 7/76/4K Phone: V - 96a 0
PLEASE SUBMIT THREE (3) SETS OF FIRE ALARM WIRING DIAGRAMS, DEVICE LOCATION PLANS AND CUT
REC " SHEETS WITH THIS APPLICATION.
APR �- INDICATE NUMBER OF ZONES ON PANEL, INCLUDING SPRINKLER ZONES, IF APPLICABLE: 3
I� MAXIMUM PLAN SIZE = 24" x 36"
CITY OF FEDERAL WAY
6i
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 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.
r ---�
Owner/Agent: Date: S 4/
0 ice Use Only (Moose do not write below this line)
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit Fee (Includes First Zone) $30.00
at all fire alarm installations. Additional Zones @ $10.00 ea.
r-
El Received Total Fees $
Route to: Fire Department
,ed by: t Date:
CD0491
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