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i01/20/2005 15.28 FAX 360 427 7798 MASON CO PERMIT CTR
1A 002
MASON COUNTY FIRE MARSHAL
F"VVIOU Masan County Bldg-111426 W Cedar St
PO BOX 186 Shetton,WA 9&%4
(350)427-9670 ExL 273 ii
Permit
Mason County Fire Protection System Permit APP lication -
Incomplete application will fnot be accepted
Owner: /2 �/ D 7 �gn/n/r /�
/� Phone#;
Al
Mailing Address:�o EyIx g� City. 6 State:(i(!f� Zip: �j 2
Site Address:f9350 f 52 3 City: ,-f State:&,/Zip:9 7z
Parcel#: /?Z 20—75'D -0j Gb Legal Description:
Lien/Title Holder:
Address: City: State: Zip:
Contractor l�D?C tY�i�i �! ✓�.�l�a� -:r )C, Phone#: �n0
Address: Sq<l r I
City State 14 Zip:
Contractor Registration#: /�j X F.� J Z�/a1$ Expiration Date.,(Z_
-lacy 5 b o
Building Square Footage(eai-t'ing&proposed): ls4W / 2 d / P /.
Building Use:4-2 upancy Classification. C311Sjrl3eti()n'Type:
i -
Type of System: Type of Work:
Sprinkler: Wet_Dry New System;
Standpipe: Wet Dry Modification:
AFA:
Hood&.Duct:
Dry Cheri: �4
Wet Chun:
Fire Pump: /
UL testified Monitoring company:
Contractors Sid Price: S
FOX FIRE PREVENTION, INC. - 1UEUU1EQ (DIP 4nL%H1( jUET/RL
P.•O. BOX 594
PORT ORCHARD, WA 98366-0594
CONTRACTORS REGISTRATION #FOXFIP1127M8
DATE I -f,�; 4tGii JOB NO.
(206) 623-2993 ATTENTION
(360 871-1 5
TO RE:
b1
WE ARE SENDING YOU Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
----------------
J !�
THESE ARE TRANSMITTED as checked below:
Q� For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit / copies for distribution
❑ As requested ❑ Returned for corrections XReturn ` corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:��
If enclosures are not as noted,kindly notify us at once.
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General/Specialty Contractor
A business registered as a construction contractor with LEt1 to perform construction work
within the scope of its specialty. A General or Specialty construction Contractor must
maintain a surety bond or assignment of account and carry general liability insurance.
Business and Licensing Information
Verify Workers' Comp Premium Status Check for Dept. of Revenue Account
Name FOX FIRE PREVENTION ���INC UBI No. 601094579
Phone No. (360) 871-1985 Status ACTIVE
Address PO BOX 594 License No. FOXFIP1127M8
Suite/Apt. License Type CONSTRUCTION
CONTRACTOR
City PORT ORCHARD Effective Date 7/28/1988
State WA Expiration Date 7/1/2010
Zip 983660594 Suspend Date
County KITSAP Previous License
Business Type CORPORATION Next License
Parent Associated
Company License
Specialty 1 GENERAL
Specialty 2 UNUSED
Business Owner Information Hide All
Name Role Effective Date Expiration Date
ZIEMKE, FRED 0 01/01/1980
ZIEMKE, SHIRLEY A 01/01 /1980 01/01 /1980
Bond Information
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=FOXFIPI127M8 8/28/2008
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