07-100308 I City of Federal Way Electrical Permit #: 07-100308-0d-Ella
Community Development Services
P.O.Box 998
_
Fe(aral Way,WA 988063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: DR BRIAN FILBERT FAMILY DENTISTRY
Project Address: 33507 9TH AVE S Bldg B Parcel Number: 926500 0020
Project Description: Installation of(2) t-stats
Owner Applicant Contractor
THREE THIRTY SIXTH-LLC EVERGREEN REFRIGERATION EVERGREEN REFRIGERATION
1611 9TH AVE N 727 S KENYON ST 727 S KENYON ST
EDMONDS WA 98020 SEATTLE WA 98108 SEATTLE WA 98108
Additional Permit Information
Electrical Fixtures
Thermostat 2
CONDITIONS:
PERMIT EXPIRES Wednesday, July 18, 2007
Permit Issued on Friday, January 19, 2007
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the ;w will be i iaccordance with the laws, rules and regulations of the State of Washington
and the_ City of Federal Way.
1 ' ' )`-7
Owner or agent: ' t� Date: l I
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THIS CARD IS TO REMAIN ON-SITE
cn;oF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 .
PERMIT #: 07-100308-00-EL
Owner: THREE THIRTY SIXTH, LLC
Address: 33507 9TH AVE S Bldg B
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections
are logged on the back of this card.
❑ Slab/Concrete Floor (4255) ■❑ Ditch cover(4030) �❑ Pool Bonding (4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) ❑ Service (4235) ❑ Feeders/Sub-panels (4045)
Approved Approved K Approved
By Date By Date By Date
❑ Rough Electrical (4225) ❑ Ceiling Cover(4020) ❑ Final -Electrical(4055)
Approved x Approved Approved
BK( 67 Date `Z A-v7 By 67 Date 'G -`;-ei By,i ,5 Date ?g�--,57
❑ Under-slab groundwork(4295)
Approved
By Date
!Yo•
C e d e Way
� 9 tip0� PERMIT ,
cowman DEVELOPMENT SERVICF�S '1 SF MF CO MEPL DE EN FP
33325 2FED FEDERAL ,WA SOUTH 98 PO BOX';.�l o����®p P LI CATI O N �.,
FEDERAL WAY,WA 98063.9718` ��P �
253-835-2607•FAX 253835.2609
www ctnaffeder aiumu.com
The allowing is re•aired information-an incom•tete a.•tication will not be acce.ted. Please •rint le*ibl (in ink)or •e.
�i, -'f / �.{� j�, • PROPERTY INFORMATION
SITE ADDRESS , 1 7'e 4-1 a"e 5• i'e 1 SUITE/UNIT# I
ASSESSOR'S TAX/PARCEL# 61 2- CO S 0 0 - Q 0 — U LOT SIZE(sj7
LEGAL DESCRIPTION(e.g.Acme Estates.Lot 1)
(Attach separate yagefor lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING CI PLUMBING -.a!! .:•I...,••
❑ DEMOLITIO LECTRICAL • ENGINEERING ❑ FIRE PREVENTION SYSTEM
PRO CT 11 RIPTION tau. • _ :... . ./ . •• n • • on i Is •erne on
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I. I.-.mil%/.. /r•�Y� `�4i1•JT/J' 1
2- -T- —�+5 /
PROJECT NAME(Name of Business or Owner Last Name) k fit- —2.A .A •
III PEOPLE INFORMATION
PROPERTY NAME / PRIMARY PHONE
l
OWNER ii rr.+Ci W 4't f J k. 1 �y ( )
MAILING ADDRESS CRY,STATE,ZIP
1? II akt, ftVe N Eamo IS1 4)- 4702-6
n..-CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
�/col rem 1q161 r4-bon l b-ydeo-rorvt ('7A )71olr - 1/44
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
12-7FEDERAL Q�� cf.ICENSE NUMBER kak r �E��TIODATE FAX NUMBER
20 - c G - 1 0 ( 4 5*- 1 -B L / / (ioG )1 r -1- c1
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPLRA N DATE
5 . G9i- - ''( . z 1 / / 6
5v 4I 1>
APPLICANT MPANY NAME APPLICANT NAME OFFICE PHONE
( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent ❑ Other(Describe) ( ) -
CONTACT PRIMARY PHONE E-MAIL ADDRESS
N (Grif, (zO ))ZV3 - 11 i 4 1i
_q
LENDER b � p x
� -4#XJn ae . NAME
MAILING ADDRESS CITY,STATE.ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPE TOTAL
sr .FT. -sp.OS FT.•D S9.FT.
BASEMENT
FIRST
SECOND
THIRD
-FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
susrwa PROPOSED
NUMBER OF FLOORS
"NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offtxture to be installed or relocated as part of this project Do not include existing fixtures to remain.
MEC CAL 6,4,c) Gu c)Value o echanical Work $ Z ^� ��
AIR HANDLING UNITS
EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS
• - . HOODS(commercial) WOODSTOVES
OILERS FIREPLACE INSERTS RANGES MISC(Describe)
OMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
i
PLUMBING
BATHTUBS(or Tab/Shower Combo)
SHOWERS WATER CLOSETS Ironetl MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTL&f5 SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(9Sthmw) VACUUM BREAKERS
mom s ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further,that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim(including costs,expenses. and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by any person,including the undersigned,and fled against the City of Federal Way,but only where such claim
arises out of the reliance ; the city,inctu trig its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. )
NAME/TITLE
1116! I I, DATE 1/ `
.lgnature) (nde)
RELATIONSHIP TO PRCJECT ❑ Owner ❑Agent Lf'Contractor ❑Architect ❑ Other
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Bulletin#100—January I,2006 Page 2 of 4 k�HandoutslPennit Application