00-105187City oiFederal Way
Applicant
Electrical Permit #:00 -105187 - 00 - EL
Community Develelopment Services
Stephen M & Vicki L Voss
ELECTRO SERVE
33530 1st Way S
4622 SW 328TH PL
Inspection request line: 253.661.4140
Federal Way, WA 98003-6210
FEDERAL WAY WA
13456 SE. 27TH PL#240
Ph: 253.661.4000 Fax: 253.661.4129
(3:30pm cut-off for next day inspections)
Project Name: VOSS
Project Address: 4622 SW 328TH
Project Description: ELE - Add outlet for gas stove
Parcel Number: 802950 0040
Owner
Applicant
Contractor
Stephen M & Vicki L Voss
Stephen M & Vicki L Voss
ELECTRO SERVE
4622 SW 328TH PL
4622 SW 328TH PL
FEDERAL WAY WA
FEDERAL WAY WA
13456 SE. 27TH PL#240
98023-1925
98023-1925
13ELLEVUE WA 98005
Electrical Fixtures
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 Wa .
Owner or agent: Date:
Q"A/
cr"OrG TRECEIVED CONSTRUCTION PERMIT APPLICATION
� � PPLICATION NUMBER: OCi_ - 10 C5
OCT 1 7 2M APPLICATION NUMBER: - - - - - -
,v OF FEDERAL WAY APPLICATION NUMBER: -
BUILDING DEPT.
**The following is required information — Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
ADDRESS: _ 7 K.i?� 2 SW. �.0 D ��r`f ASSESSOR'S TAX/PARCEL #:
L DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): A&4
OF PROJECT (This application): ❑ �SUILDING I] PLUMBING El MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
DESCRIPTION (Provide detailed description):
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
NAME:
DAYTIME PHONE:
(x.53) Ste- 6s�ao
MAILI��SS (STREET ADDRESS; CITY, ��ZIP :
Z
NAME:
�c r die
DAYTIME PHONE:
(f fr) �/1W
MAILING ADDRESS (STREET ADDRESS; CITYYY STATE,):
14 ice. G..,9J�-
EVENING PHONE -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
APPLICANT: NAME: r DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: '' FAX NUMBER:
❑ ARCHITECT El TENANT OTHER (DESCRIBE): (/"�•' ( ) -
�� E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ElM PROPERTY OWNER APPLICANT UoeONTRACTOR
0 DETAILED BUILDING INFORMATION
EXISTING USE:
PROPOSED USE:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
PROPOSED VALUATION FOR IMPROVEMENTS:
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
■ PR03ECT FLOOR AREAS
FLOOR
XI
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 FOUNTAINS)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
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. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(5)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MISC. ( )
SUMP(S)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and
rther, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
rther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
testigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of
deral Way, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
the information the city as a part of this application.
IME/TITLE:- DATE: l� —
PROPERTY OWNER ❑ APPLICANT
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • P.O. BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129