09-101192tfFederal Way
ComnunutyDevelopment Services Electrical Permit #:02 -101192 - 00 - EL
33530 Ist Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: VALLEY RADIOLOGIST
Project Address: 181 S 333RD Suite210 Parcel Number: 926500 0258
Project Description: ELE - Alteration of up to (5) circuits in corridor located on 2nd floor.
Owner
Applicant
Contractor
Josef & Alhadeff Jerry Diamond
NORTH STAR ELECTRIC
NORTH STAR ELECTRIC
515 116TH AVE NE #170
1905 S JACKSON ST
1905 S JACKSON ST
BELLEVUE WA
SEATTLE WA 98144
SEATTLE WA 98144
98004-5224
(206) 329-159
Electrical Fixtures
'.. Desai tion Q tib; a°'3 t "'F, ton r: ;&, ,. uant Descrl
Q Qtiariti
Circuits - Commercial 5
PERMIT EXPIRES September 16, 2002, IF NO WORK IS STARTED.
• 1 hereby certify that the above information is
the occupancy and the use will be in accor
the City of Federal Way. _
Owner or agent:
Permit issued on March 20, 2002
rect and that the construction on the above described property and
with the laws, rules and regulations of the State of Washington and
CAP l, (PAh
F •�k� �e evov�e� � . S ,
Date: 3 -,.n20 - Q oZ
a—
0
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
PROPERTY O.MATION
h
SITE ADDRESS: 18/ So u4 3 3 .3 rcl .s7rccT- ASSESSOR'S TAX/PARCEL #: f7- (0 _ — OL.S-
-TLI ,' tQ -;1/0
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROIECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
.ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): /O &-) Gk/n/G' -i q A fs / N C 6 r ri Cl o a .3
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
I'IAM � DAYTIME PHONE:
A l�C,y t2ad� i C'oloei', sus (4/025) `5ra-�O0 S
MAILING ADDRESS eSTREET ADDRESS; CITY, STATE, ZIP)!
IB"/ Som 1-4 333rd sr. .5rc-.21d
NAME:
oA T r�Q �' ,'c
DAYTIME PHONE:
(amu /.)
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
�CSl
EVENING PHONE:
4
Z'705 a aJ �� �i'y
( " )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
aa-()o,(� g 8_-b d - 133 L
(a64.) 3.2?
-?tyf7
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
/a / 3l
/62000.
(oDpyofcard requ
APPLICANT: NAME: DAYTIME PHONE:
5�ql 1 e NO /Z -
MAILING ADDRESS (STREET ADDRESS; CRY, STATE, ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT b -CONTRACTOR
EXISTING USE:
PROPOSED USE:
■ DETAILED BUILDING INFORMATION
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
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)
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. ( )
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) MISC. ( )
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 clai rises out of the reliance of the city, including its officers and employees, upon the accuracy
of the information supplied to the Was a part of this application.
NAME/TITLE: l/ DATE: /
❑ PROPERTY O ER ❑ APPLICANT dg -CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES - 33530 FIRST WAY SOUTH - PO BOX 9718 - FEDERAL WAY, WA 98063-9718 - 253-661-4000 - FAX: 253-661-4129