93-102315 �� ;�.- ����
. PERMIT � �,
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Job Address: - ���f �. ���� �i'�r-���.. (-�17' ,�A �Ck��
ISveetl ICitYI ISt�tel IZipl fSuite sl
Owner: %Zt�.��� jZvsv�l�',�. -ti. -���_ Tenant Name: ���-"-'-�
Contractor: ��rt,,�/��- �,� �p�E,f� �,�L Tax Parcel #
Address: .�-'r� �._ "`9�a�&�,n�/�-c_- i.t,�+v .S .`�1= i , c= �� ai i�l 3¢-
Phone: (,vZF� -�v Contractor License #: ��h/,c4���� ��) Expiration Date: � s���
IC�rd muat be presented)
Owner's Address: c�,,,",� Phone:
Contact Person: �7;,�.; i,+� Phone: ��'��"����
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 20NES, IF APPLICABLE: J 't��tJ N�
MAXIMUM PLAN SI�E = 24'� X 36'�
, 1 CERTIFY UNDER PENAtTY OF PERJURY THAT THE INFORMA'fION FURNISHED BY ME IS TRUE AND CORREC7 TO THE BES74
` OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER �F THE ABOVE PREMISES TO PERFORM THE '
WORK FOR WHICH PERMfT APPLICATION IS MADE. I FURTHER AGREE TO SAVE iiARMLESS THE CITY OF FEDERAL VI/AY AS
' TO ANY CLA1M (INCLUDING COSTS,EXPEN8ES,AND AT70RNEYS'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 ONtY WHERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING tTS OFFICERS AND '
;, EMPLOYEES,UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITYAS A PART OF THIS APPLICATION,
t `^�
Owner/Agent: ��,.,� _ Date: �' ���
� O�ce Use Only(P/ease do not write below this/inel
Remarks:
Department of Labor and Industries
Electrical Permit shall be posted Permit Fee (Includes First Zone) S30.00
at sll fire alarm installations. _Additiopal Zones @ S 10.00 ea.
� . r.
a � -
� Received
Total Fees $ : �, �.
Route to: Fire Department
Approved by: �} � Date:
CD0491
SEP 0 7199�
�BUiLD1NG DEPT. AY