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SITE LOCATION <br />CITY OF TUKWILA <br />FIRE DEPARTMENT <br />444 Andover Park East <br />Tukwila, WA 98188 <br />206-575-4407 <br />Date application <br />accepted: <br />FIRE PROTECTION SYSTEMS PERMIT APPLICATION <br />Applications and plans must be complete in order to be accepted for plan review. <br />**PLEASE PRINT** <br />King Co. Assessor's Tax No.: 362304-9011 <br />Site Address: 17900 West Valley Highway Suite Number: Floor: <br />Tenant Name: NC Machinery <br />Property Owner's Name: NC M a c h i n e r y <br />Mailing Address: <br />New Tenant? ❑ - Yes ® - No <br />17900 W. Valley Hwy, Tukwila WA 98188 <br />City State Zip <br />CONTACT PERSON -if there are questions about the submittal. <br />Name: Janet Stebbins <br />Company Name: SimplexGrinnell <br />Mailing Address: <br />Day Telephone: 206-291-1468 <br />9520 10th Ave S, Suite 100, Seattle WA 98108 <br />City <br />State Zip <br />E-mail Address: jastebbins@simplexgrinnell.com Fax Number: 206-291-1500 <br />Valuation of Project (contractor's bid price): $ 16,042.20 <br />Scope of Work (please provide detailed information): Install Dry System with (27) sprinklers <br />supplied from existing wet system in tenant improvement. <br />PERMIT APPLICATION NOTES <br />Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be <br />reviewed and is subject to possible revision by the Fire Marshal to comply with current fee schedules. <br />Expiration of Plan Review -Every permit issued shall become invalid unless the work on the site authorized by such permit <br />is commenced within 180 days after its issuance, or if the work authorized on the site by such permit is suspended or <br />abandoned for a period of 180 days after the time the work is commenced. The Fire Marshal is authorized to grant, in <br />writing, one or more extensions of time, for periods not more than 180 days each. The extension shall be requested in writing <br />and justifiable cause demonstrated. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE <br />UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OR WASHINGTON, AND I AM AUTHORIZED TO APPLY <br />FOR THIS PERMIT. <br />BUILDING OWNER OR AUTHORIZED AGENT: <br />Signature: <br />Print Name: Janet Stebbins/SimplexGrinnell <br />Date: 01/03/12 <br />Day Telephone: 206-291-1468 <br />Plan Permit App.doc 5/14/10 TFD FP Form 8 <br />