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CITY OF FEDERAL WAY FIRE PROTECTION SYSTEM PERMIT PERMIT NO.: FPS97-0008
33530 First Way South FIRE DEPARTMENT INSPECTION - 946-7318 ISSUED: 03/14/97
�ederal Way, WA 98003 BY: FC
661-4000
SITE ADDRESS: 34515 9TH AVE S ,
PARCEL NO.: 202104-9117
PROJECT DESCRIPTION: FIRE ALARM PERMIT APPLICATION
OWNER CONTRACTOR LENDER
ST FRANCIS HOSPITAL D W CLOSE CO INC
34515 9TH AVE S P 0 BOX 24246
FEDERAL uAY uA 98003 SEATTLE NA 98124
623-8960
DWCLOCI21805
SPRINKLERS?........:? HOOD & DUCT?.......:?
FEES:
# 20NES..........: 2 OTHER.....: FIRE ALARM FEE.....* S 40.00
FIRE ALARM SYSTEM?.:? EXTENT OF WORK...:? FPS PRMT ISSUANCE. S 20.00
# ZONES........... 0
STANDPIPE?.........:?
UG FIRE SERVICE?...:?
FIXED SVSTEM?......:?
TOTAL FEES $ 60.00
INSPECTION RECORD
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED.
l 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.
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OWNER OR AGENT ��'"L�r�� ��i2i�aal� DATE � �7 �%
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Job Address: ! �.. : , � _r$ =1 ��e.l2.�1(� l.✓I'-� �$O�3
ISnxU ICitrl IS���el lZipt ISuce/I
Owner. ��. Fi'�l�iN G.l 5 �-�cS�C? Tenant Name: C�t ��N
Contractor. �. �/, G�-Q$ E C4W1�/�I�t_��I�t�Tax Parcel #
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Address: 33�� �K� /QVG �O S�M'["Tl.� 1,✓/'�l �FS � 3`-�
a46
Phone: Ge'�-3'$`�CoO Contractor License #: � - - r I .. ��._�.i .i ,; `-Expiration Date: � �' �
�c,�a m�.t be w�rned�
Owner's Address: �fl+'Yt E 1°1� ft�nV E Phone:
Contact Person: (�ON '�A E.��M Phone: ('°�3 �����
PLEASE SUBMIT THREE (3) SETS OF FIRE ALARM WIRING DIAGRAMS, DEVICE LOCATION PLANS AND CUT
SHEETS WITH THIS APPLICATION.
INDICATE NUMBER OF 20NES ON PANEL, INCLUDING SPRINKLER ZONES, IF APPLICABLE:
MAXIMUM PLAN SI�E = 24" X 36�
1 CERTIFY UNDER PENAtTY OF PERJURY THAT 7HE 1NFORMATlON FURNISHED BY ME IS TRUE AND CORRECT TO 7HE BEST
DF MY KNOWLEDGE AND FURTHER THAT 1 AM AUTHORIZED.SY THE OWNER OF.THE ABOVE PREMISES TO'PERFORM THE
WORK FOR WHICH PERMIT APPUCATION 1S MADE. 1 FURTHER'AGREE TO SAVE i�iARMLESS 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 FlLED AGAINST THE CiTY OF. >
FEDERAL WAY, BUT ONLY WHERE Sl1CH CL'A1M ARISES OtJT OF THE RELIANCE'OF THE C1TY,INCWDING ITS OFFICERS AND
'EMPLOYEES;UPON THE ACCIfRACY OF THE'INFORMATION'SUPPUED TO THE CtTY AS A PART Of THIS APPUCATION.
OwnerlAgent: `� Date: ` ` '
O�ce Use Only (Please do not write be%w this linel
Remarks:
Department of Lebor and Indust�es
Electrical Permit shall be posted Permit Fee (Includes Frst Zone) S30.00
at ell fire elarm installations. �Additional Zones @ S 10.00 ea.
D Reeeived Total Fees S
Route to: Fire Departmant
Approved by: Date:
c�oaet