02-100237 t:frlf CF !- BUILDING DIVLSION
• � �� 33530 First Way South
� ) Federal Way,WA 98003 !i
(253)661-4000
Fax(253)661-4129
FIRE PROTECTION SYSTEM APPLICATION
Federal Way Business License number: „'' -.___'--.-17 l`
FPS
PARCEL# Commercial 0 Residential 0
SITE LOCATION
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Tenand0lvner �ZG A r
s ' ` , % �6zOf; S ) `?•, ms'. r�'(` f1>w/ .,�iGcilGAddress/City/State/Zip
Nature of Work Z.,,,,,,,,_,,) E�s�i '�� �t.v`` !-' �° /0��'-'� Project Valuation:$ 1 2.1e) '
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APPLICANT -s `
Name
Address/City/St�Zip ' v - `, . t ) z,,,,,?��v�+` ( ,iif 90.06__36,,'
Contact Person ��, `�`0,1 r Phone y25 -7X/- Vit?.j Fax Liz 77y�3/
CONTRACTOR /
Company Name
Address/City/St/Zip / 20J' � Z,7 ../( IJ cld�O3Fa
�� 471 , 7?V- Fc'-? F 7"-257)9,_
>� 1v3
Contact Person y Phoneax
State L&I Contractor Registration# PR 5-75-C f° L�'' Exp.Date 513i 3
(Card must be prerented)' -
PLEASE SUBNIIT THREE (3) SETS OF DRAWINGS AND CUT SHEETS,PER NFPA STANDARDS.
IVIAXIlYIUM PLAN SH, ET ST7F: 24" x 36"
DISCLAIMER:
I certify,underpenalty of perjury,that the information famished by me is hue and eased to the best ofmy 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 farther agree to save harmless the City of Federal Way as to any claim(mciuding costs expenses and attnuaeys'fees lammed in investigation and defense of such claim),which maybe
made by any person,including the undersigned and fled against the City of Federay Way but only where such claim eases out of the reliance of the city,including its officers and employees,upon the accuracy of the
information suppled to the city as a part of this applicators _
"". -•<-."'------ Date l f' 61 Z
Owner/Agent
•
'RLvrsPD ill9/99 s
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