07-100310 City of Federal Way
Community Development Services Electrical Permit #: 07-100310-00-EL
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax'.(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: CAMILLE VANDEVANTER DENTAL OFF
Project Address: 33507 9TH AVE S Bldg G Parcel Number: 926500 0020
Project Description: Install 2 t-stats
Owner Applicant Contractor
SOUTH 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
s.
Additional Permit Information
Electrical Fixtures
Thermostat 2
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 u will be in acc rdance with the laws, rules and regulations of the State of Washington
n the City of Federal Way. 7
Owner or agent: �> Date: 1M/6 /
F%DIALED
THIS CARD IS TO REMAIN ON-SITE •
CITY OF Community Development Inspection Record -
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 07-100310-00-EL
Owner: SOUTH THREE THIRTY SIXTH, LLC
Address: 33507 9TH AVE S Bldg G
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 Approved
By Date By Date By Date
❑ Rough Electrical (4225) ❑ Ceiling Cover(4020) ❑ Final -Electrical(4055)
Approved Approved Approved
B C � Dater'(—r.(? By Date j j Date
❑ Under-slab groundwork(4295)
Approved
By Date
CITY aF D - _i_ O O 3 1 O
Fed
V
eral Way CE�� PERMIT
COMMUNITY DEVELOPMENT SERVICE_ SF MF CO ME @ PL DE EN FP
3332FED'AYENUY,WA 9•POBOX 9778��� 9 APPLICATION �.,
FEDERAL WAY,WA 98063.9718
• 253-835-2607•FAX 253.835.2609
wu.to Mtnffederniv,au.co,n
•The ollowin. is ree • '.(+ • AI `� �
_ ,� tLs+ -17.. incom.Iete a. .licatiort will not be acce•ted. Please .rinf le•ibl (irt ink)or p
}� • PROPERTY INFORMATION
ff
SITE ADDRESS ?VA 6 1 1 114 v\ t p i• -14'14 -2-00 (� SUITE/UNIT it
ASSESSOR'S TAX/PARCEL# 2 ) S 4 1 ) - ()J t 1 " LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(AHaclt separate page for lengthy legal descr(ptIon)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING - -
❑ DEMOLITION-If-ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PR a. -C D,E)SC: I• ION(Provide de a'-d description o work included on this permit only)4.
w.�i) •41,1 /l x'0.461. eA�it12 S. 1L3 / ra..1" d• W4' - S•o'
_tom
PROJECT NAME(Name of Business or Owner Last Name) vg. (a' ii e V4 ti VI/MYI
1�q -Ay � p 1 IN PEOPLE INFORMATION
PROPERTY OWNER NAME n-1 t I CA �?.(i ILj `j1 '' PRIMARY PHONE( )
MAILING ADDRESS Jei (G0 CITY,STATE.ZIP -
1-6) 0 1 19 -HI I 't Avg f3-e IfoN i 449- , 41 001
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
i F.Vetol 4til �i�41 ®$YA4-1 h - -vvrt (-we ) 167 17N.l MAILING ADDRESS CITY. ATE,ZIP 4 (U CELL PHONE
M121 mill 14 • j ► 1 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2 0 - 0 ( - 1 0 ( 4 S "f -B L / / (-./04 )-lt. - 2,"7''8
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each EXPIRATION DATE
rvkfL61z � i3L) a2 application) ,EXPIRATION
/a"$
APPLICANT COMPANY NAME - APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent ❑ Other(Describe) ( ) -
CONTACT T PRIMARY PHONE E-MAIL ADDRESS
'v1 (wrt ('vab)7(9.i 1714 ii
LENDER r • we,St'it -I •ft.S. ' NAME
` Yd'h 't a.
MAILNG ADDAESS 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 ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) .
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
-FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
axrrrmo rnorosso `S - r. ? .^m. r------r--•--;7.77,7,77:-.-.7•-,41. 444
NUMBER OF FLOORS 5di.a 2ir. z ,« r ..`_ • rs k' ° *`
"NEW HOMES ONLY" NUMBER OF BEDROOMS — ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include extsting fixtures to remain.
MECHANICAL a
Value echanicai Work $ '�/ T S CV l r
AIR HANDLING UNrrS --- �APORATNE COOLERS (/GAS LOO GS _1 REFRIG.SYSTEMS
BBQS FANS HOODS(commaball WOODSTOVES
BOILERS (/ FIREPLACE INSERTS RANGES MIST(Describe)
COMPRESSORS FURNACES .GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
,.
' PL LNG
BATHTUBS(ormb/Shower Combo) SHOWERS WATER CLOSETS trouts MIST(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
[.AVS(Bathroom smka) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct Yo 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 tatty 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 filed against the City of Federal Way,but only where such claim
arises out of the reliance of city,in ding its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE 1 /14 /P7
Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑Agent Contractor ❑Architect ❑ Other
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Bulletin#100—January 1,2006 Page 2 of 4 k\HandoutslPermit Application
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