95-100929 9 5- )O69 9
CITY OF FEDERAL WAY FIRE PROTECTION SYSTEM PERMIT PERMIT NO.: FPS95-0017
33530 First Way South FIRE DEPARTMENT INSPECTION - 946-7318 ISSUED: 05/25/95
Federal Way, WA 98003 BY: FC2
661-4000
SITE ADDRESS: 31623 1ST AVE S
PARCEL NO.: **JJ3*—
PROJECT DESCRIPTION: FPS — FIRE ALARM PERMIT WITH 5 ZONES
-- OWNER — CONTRACTOR LENDER
LAKEHAVEN UTILITY DISTRICT CARTLAND ALARM
31623 1ST AVE S P 0 BOX 3407
FEDERAL WAY WA 98003 LACEY WA 98503
1516 827-8400
CUST041254PT
SPRINKLERS? ' HOOD & DUCT? •? FEES:
# ZONES 0 OTHER FIRE ALARM FEE * $ 30.00
FIRE ALARM SYSTEM?.:Y EXTENT OF WORK •? FIRE ALARM FEE * $ 40.00
# ZONES 5 FIRE DEPT FEE * $ 35.00
STANDPIPE? •?
UG FIRE SERVICE? -9
FIXED SYSTEM? •?
TOTAL FEES $ 105.00
INSPECTION RECORD
11110
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 7L C,—/C
fps_prmt 07/01/92
REIENED
PERMIT # � / FA
MAY 101995
C i t . :, 7. ederal Way
FIRE ALARM PERMIT APPLICATION
Job Address: S 1 C'Z 3 15' A'. E - SP . FrOC✓f4L WA-. 18-0423
(Street) (City) (State) (Zip) (Siete+►)
Owner: 4 KE fr(r°vp U i lLIr 06-1(Z‘67- Tenant Name: 2' ''`lr
Contractor: Cti1"rtl Lk}N(D A(„4,60i Tax Parcel #
1"
Address: -6 60x 3467 Ltk-Ce-Y / wA'+ • & 3
Phone:,q)v ' Z 7- 6(145 Contractor License #: 14 4IL.I✓` 6J: 33-SL.)Expiration Date: � 3/ 1.7
.--
(Card must be presented)
Owner's Address: 3 1 io 2"-7 t s i A JE . j c,. Phone:
Contact Person: -)179--,(1,4-5 5 r T Phone: 55 ' 227 6945
PLEASE SUBMIT THREE (3) SETS OF FIRE ALARM WIRING DIAGRAMS, DEVICE LOCATION PLANS AND CUT
SHEETS WITH THIS APPLICATION.
INDICATE NUMBER OF ZONES ON PANEL, INCLUDING SPRINKLER ZONES, IF APPLICABLE: r,
MAXIMUM PLAN SIZE = 24" X 36"
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 APPUCATION 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.
Owner/Agent: Date: 19 /q5—
Office
Use Only (Please do not write below this line)
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit Fee (Includes First Zone) S30.00
at all fire alarm installations. Additional Zones @ $10.00 ea.
❑ Received Total Fees $
Route to: Fire Department
Approved by: Date:
CD0491