02-100009City unity Development Services Federal Way
Community Electrical Permit #: 02 -100009 - 00 - EL
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: MITCHELL
Project Address: 1020 S 372ND WAY Parcel Number: 322104 9133
Project Description: ELE - Wiring for new elevator - Extend existing 220 v. line 8 feet.
Owner
Applicant
Contractor
ROY MITCHELL
ROY MITCHELL
ROY MITCHELL
1020 S 372ND WAY
1020 S 372ND WAY
1020 S 372ND WAY
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
(253)815-8844
Electrical Fixtures
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Circuits - Residential l
PERMIT EXPIRES July 1, 2002, IF NO WORK IS STARTED.
Permit issued on January 2, 2002
• I 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 accordance with the laws, rules and regulations of the State of Washington and
the City of Federal W —
Owner or agent: Date:
� — 12 — 0 Z Q-&.'
o�
o
SITE ADDRESS: S=T2-2 ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
OELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAM DAYTIME PHONE: t�
NAY.
e25- ) V � - W7
(STREET ADDRESS; STATE,
NAME:
�t
DAYTIME PHONE:
-
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING
NING PH ONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAXNUMBER.
— — — — — —
— — —
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE-
ATE(copy
(copyof care! required)
NAME: DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE.
RELATIONSHIP TO PROJECT: FAX NUMBER.
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR I
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE:
PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY"
NUMBER OF BEDROOMS:
ESTIMATED SELLING PRICE:
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILER(S)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S)
FIREPLACE INSERT(S) RANGE(S) MISC. ( Y )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
WATER HEATER(S)
❑ ELECTRIC ❑ GAS
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 (inducting 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 the city, including its officers and employees, upon the accuracy
of the information su ed to the city as a part of this application.
NAME/TITLE: ZDATE:
PROPERTY OWNE ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 2S3-661-4000 - FAX: 253-661-4129
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www.ci.federal-way.wa.us
Affidavit in Lieu of General Contractor Registration
State of Washington
County of King
i// , state as follows:
(Pri name as signed)
1. I have made application for a building permit from the City of Federal Way, Washington.
I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington (RCW), a copy of which is printed on the reverse side of this affidavit.
3. I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Federal Way must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Federal Way of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090, I
consider the work authorized under this building permit to be exempt under No., and will
therefore, not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engage an unregistered contractor to perform construction work.
4APPLIC
Siand sworn to before me this
Day of
, 2001.
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NottuN's Nanw Wrint) n .
Notary's Signature
NOTARY PU13LIC in and for the
St
Pie of Washington, residing at
/, /n/ County.
My Commission expires: 1 O10 - os-
Bulletin
S
Bulletin N 116 - April 26, 2001 Page 1 of 2 k:\I landouts - ttevisemuontractor s 11,111uaV IL