08-103974Fes 'vvaRECE1AQ3ERMIT
CWT
CDILIlUM7YnEvscoPABBrsselQCEs SF MF CO ME PL DE EN FP
93375dyAVENUE,WR 8POBOX9718 AUG 21 APPLICATION
53.83 AL WAY, FAX
98063.9716 /
253 -Q95 -?607• FAX 259-R35-2609
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The foiiowt4 sFi Qfd t fiQA airYi"Wletc application will not be aecepted. Please print iegibiy (in ink) or type.
SITE ADDREaa _ -, �✓ ,_ . _ - _ SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # — — — — — ,_ — — — — LOT SIZE (sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
PROJECT•- •
TYPE OF PERMIT ❑ BUILDING ❑ UMBING ❑ MECHANICAL
11 DEMOLITION ECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
scn)2#on of work included on
•t'f In (!� ice, 1%P
r
PROJECT NAME (Name ofBusiness or Owner Last Name)
PROPERTY
NAME
PRIMARY PHONE
OWNER
L e(
-
RELATIONS PROJECT
❑ Archi ❑ Tenant ❑ Agent ❑ Other
MAILING ADD110
CITY, STATE, ZIP
E-MAIL ADDRESS
MAILING D
as hn I�
ehve�r
CELLPHONE
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
COMPANY NAMECANT
t
OFFICE PHONE
NAME
OFFICE PHONE
CELL PHONE
RELATIONS PROJECT
❑ Archi ❑ Tenant ❑ Agent ❑ Other
Coy" c
I -
MAILING D
C ATE,
CELLPHONE
CITY F E
WAY BUSINESS LICENSE NUMBER
TION DATE
NUMBER
99 1O
/FAX
1 -
CONTRACTOR'S
TION NUNN=
DATi
E -MAN. ADDRESS
MN
0
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
OADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONS PROJECT
❑ Archi ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME PRIMARY PHONEE-MAIL ADDRESS
4----7 1 ( rI
NAME
Per RCIV 19.27.095.
Lender information is required if project value exceeds $5,000
MAILING D
CITY. STATE, ZIP
PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORT{
SPRINILERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SO. FT.
TOTAL
SQ. FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
1
-h
WASHING MACHINES '.
SECOND
SUMPS
UP/8EPA/SII? o YES
o NO
THIRD
o YES o NO
DEMO PERMIT REQUIRED? o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
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rsorosto
Toren.
roE.msararusar
r Mimoroswar
miser
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICA77ON)
AIR HANDLING UNITS EVAPORATIVE COOLERS OAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS I9
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (.Tah/eh.,comhy
LAVS 0s.m-3hdA
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (e"&q
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES '.
HOSE BIBBS
SUMPS
UP/8EPA/SII? o YES
I eertV& under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best of my
knowledge, the bVermatlon submitted in support of this permit application is true and correct I eert(/y that I will comply with all applicable
City of redowl Way regulations pertaining to the work authorised by the issuance of a permit I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws.
I •/further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fee: incurred in the
investigation and dtfense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out of the reliance of the —l"y, inc its 6i6%ers-z*1fempiogess, upon the accuracy of the information supplied to
the city as a part ofd applicati�fi.
SIGNATURE:
1�7d101
C52
a NEW o ADDITION
o ALTERATION
a REPAIR o, TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES o NO
BASIC PLAN? G YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP/8EPA/SII? o YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED? o YES
o NO
Bulletin #100 —January 1, 2008 Page 2 of 4 k\Handouts\Penr it Application
CiyD Federal Way Electrical Permi*• 08 -103974 -00 -EL
Community Development Services •
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609 99 4 93 Inspection Request Line: (253) 835-3050
Project Name: QWEST DSL SITE
Project Address: Parcel Number: CITY WIDE
Project Description: Service installation at the end of cul-de-sac' on 11th PL S.
Map is attached
Owner
Applicant
Contractor
QWEST
KEN BOBKO ELECTRIC CO INC
KEN BOBKO ELECTRIC CO INC
1005 17TH ST ROOM 1570
PO BOX 7009
KENBOECO66BA ( 1/1/10)
DENVER CO 80202
TACOMA WA 98406-0009
PO BOX 7009
TACOMA WA 98406-0009
Additional Permit Information
Service greater than 1000 Amps?...........................No
Electrical Fixtures
New Service/Feeder: 0 - 100 amps 1
PERMIT EXPIRES Friday, August 21, 2009
Permit Issued on Thursday, August 21, 2008
1 hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in acc dance with the laws, rules and regulations of the State of Washington
and th ity f ay.
Owner ora `
agent:
Date:
9 ��
THIS CARD IS TO AIN ON-SITE
CITY OF CommunityDevelo me t Ins ectlon Record P p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 08 -103974 -00 -EL
Owner: QWEST
Address:
FEDERAL WAY, WA
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.
❑ UFER Ground (4295)
❑ Ditch cover (4030)
❑
Slab/Concrete Floor (4255)
Approved
Approved
Approved to place concrete
By Date
By Date�'Z2 0 NJ
By
Date
❑ Pool Bonding (4195)
❑ Temporary Power (4275)
❑
Service (4235)
Approved
Approved
Approved
By Date
By Date
By
Date
❑ Rough Electrical (4225)
❑
Ceiling Cover (4020)
❑ Feeders/Sub-panels (4045)
Approved
Approved
Approved
By. Date
By Date
By
Date
❑ Final - Electrical (4055)
Approved
By Date
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date