02-102233w
r
City of Federal Way
Community Development Services Electrical Permit #:02 -102233 - 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: PIERSON
Project Address: 33411 22ND SW a N r: 932090 05
Project Description: ELE - Replace (4) fire damaged circuits
Owner Applicant Contrac
Terry J & Tammy L Pearson MUNION & SETH ELECT CON kMN & SETH ELEC A N
33411 22ND AVE SW 19725 SE 281ST ST E 281ST ST
FEDERAL WAY WA KENT WA 98042 A 9
98023-2805
Circuits -
• I hereby certat the above i
the occupancy aQp' 13611
the City of Federal
( ,c
Owner or agent:
5-- 31-0-A.
4
Electrical Fixtu
LES November
Permit issued A
is correct
I
2 ORK IS STARTED.
)2002
ion on the above described property and
1d regulations of the State of Washington and
S G R✓1Ge C �. - P --6&7j
Date: 02,
/ Ce(ZV
•
t
RECEIVED
;ofGCONSTRUCTION PERMIT APPLICATION
_
VV F3Y MAY 2 9 2002 APPLICATION NUMBER:
APPLICATION NUMBER:
CITY OF FEDERAL WAY
BUILDING DEPT. PPLICATION NUMBER:_—
**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.
SITE ADDRESS:
ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): L) BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE
PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 12� ba -e— G `ycU L T5
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
rj
NAME: � DAYTIME PHONE -
�J �� /�
MAILING ADDRESS (STREET AD ; CITY, STATE, IIP): 33 J I ( !i/ " A*5 J ,
NAME:DAYTIME
V h ( O ft 7}' IC LLQ
PHONE:
G J
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
(57,7S- 291'57 l�r.�-1 am !d (� SIL-
EVENING PHONE:
(25S ) W S'_ -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
Awa - - - - - - - - - - - -
(Z9_3) 630 -S7l/
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of Xatd required)
NAME:
(�J ( ?G4_ )7f 6 - 2 -
MAILING ADDRESS _�a CITY, STATE, /L). EVENING PHONE
-
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE):
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS:
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESS PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ HIGHLINE ❑TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** r
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PR03ECT FLOOR AREAS
7m -
FLOOR
NGS . FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
FANS)
HOODS)
WOODSTOVE(S)
FIRST
FIREP E INSERTS)
RANGE(S)
MISC.
SECOND
FURNA E(S)
THIRD
GASP E OUTLET(
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
FOURTH
LUMBING
OTHER DORS (DESCRIBE)
LA TORY )
URINAL(S)
WATER HEAT (S)
DE
NWA R SYS.
VACUUM BREAKERS)
❑ ELECTRIC ' ❑ G
GARAGE
HOW MANY FLOORS?
SH W (S)
WASH MACHINE OUTLET
TOTAL:
SIN )
WATER CLOSET(S)
MISC.
Indicate n¢mber of each type of fixture
/J MECHANICAL
AIR HANDLING UNIT(S)
EVA E COOLER(S)
GAS LOGS)
REFRIG. SYSTEM( )
BBQ(S)
FANS)
HOODS)
WOODSTOVE(S)
BOILERS)
FIREP E INSERTS)
RANGE(S)
MISC.
COMPRESSORS)
FURNA E(S)
DUCTS)
GASP E OUTLET(
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
LUMBING
BATHTUBS)
LA TORY )
URINAL(S)
WATER HEAT (S)
DISHWASHERS)
NWA R SYS.
VACUUM BREAKERS)
❑ ELECTRIC ' ❑ G
DRINKING FOUNTAIN(S)
SH W (S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SIN )
WATER CLOSET(S)
MISC.
INTERCEPTORS)
SUMPS)
�iSCLAiMER/SIGNATURE BLC
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 s claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
of the inforrnation s plied t e city as a part of this application. / G,
/NAME/TITLE: (J �( DATE:
/r
t ///111
t
t
r
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33S30 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 •253-661-4000 • FAX: 253-661-4129
www.dtvoffederalway.00m