00-105553City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: OSH KOSH B'GOSH
Project Address: 32065 PACIFIC S
Project Description: ELE - Install 4 t -stats
Electrical Permit #:00 -105553 - 00 - EL
Inspection request line: 253.661.4140
(3:30pm cut-off for next day inspections)
Parcel Number: 150050 0120
Owner
Applicant
Contractor
JDI TACOMA LIMITED PARTNE
NONE
EVERGREEN REFRIGERATION INC
29 N WACKER DR
CHICAGO IL
727 S KENYON
60606-3203
NONE
SEATTLE WA 98108
Electrical Fixtures
Description Quanti
Thermostat 4
PERMIT EXPIRES May 12, 2001, IF NO WORK IS STARTED.
Permit issued on November 14, 2000
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 Way.
Owner or agent: :,124 /-i Date:
CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER:
APPLICATION NUMBER:
PPLICATION NUMBER: - -
**TheMM(g6, r6jmCir d -information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
ffII PROPERTY•. •
SITE ADDRESS: A a I LDS t bbl 1 fl, t (, (A)l/ - S ASSESSOR'S TAX/PARCEL-#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
C9 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): Z n -i i G I I L4 T- 5 T O� jS
PROJECT NAME:
"PROPERTY OWNER:
CONTRACTOR:
NAME: I DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
NAME:
DAYTIME PHONE:
MAILING (STR ET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
-ADDRESS
d
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUM R:
FAX NUMBER:
_ _
- _ _ _
_ _ _ --
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
P_ V
Ee.Gs R
QSC_
S
/.;2S/a
APPLICANT: NAME:
MAILING ADDRESS (STREET ADDRESVdff
❑ ARCHITECT ❑ TENANT A OTHER( DESCRIBE): U n+rar�o r
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT MCONTRACTOR
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER: Cl LAKEHAVEN
SEWER SERVICE PROVIDER: 0 LAKEHAVEN
EVENIN PHONE:
( )
FAX NUMBER:
QbL )_71P3
E-MAIL ADDRESS:
PROPOSED VALUATION FOR IMPROVEMENTS: $
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
0 HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
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)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHERS)
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)
FIREPLACEINSERT(S) RANGE(S) MISC.(
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MM.( )
SUMP(S)
■ 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 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 supplied to the city as a part of this application.
NAME/TITLE: � . t/V1 /i i lei / DATE: `` l 2y Dy
❑ PROPERTY OWNER ❑ APPLICANT )� CONTRACTOR r v
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129