02-102192City of Federal Way
Community Development Services Electrical Permit #:02 -102192 - 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: NADEAU
Project Address: 30155 25TH SW Parcel Number: 893760 0110
Project Description: ELE - Alteration of up to (4) circuits for kitchen remodel in existing residence.
Owner
Applicant
Contractor
Susan K Tommervik
NONE
EVERGREEN STATE ELECTRIC INC
30155 25TH AVE SW
PO BOX 1448
FEDERAL WAY WA
ORTING WA 98360
98023-2371
NONE
(253) 770-0656
Electrical f=ixtures
"` pscripti6nf Qii' t ecrption -:~ Ciiaot „'` "r'' Descri 'tion `, Quanti
Circuits - Residential ..
PERMIT EXPIRES November 20, 2002, IF NO WORK IS STARTED.
Permit issued on May 24, 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, rul-s and regulations of the State of Washington and
the City of Federal WA I I A _ ,
Owner or agent: _ Date:
M
RECEIVED CONSTRUCTION PERMIT APPLICATION
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APPLICATION NUMBER:
MAY 2 4 2002 APPLICATION NUMBER: _
C11Y OF FEDERAL WAY APPUCATION NUMBER:
NN DEPT. ----- --
**The folloW��'r'equired information - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS: _ "W1 5 ZS q�/ S (•�, �C.- n4.-�f ASSESSOR'S TAX/PARCEL #: `��'- - 1
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
19 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): keddoi z
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PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: DAYTIME PHONE:
MAILING ADDRESS STREET ADDRESS, CITY, STATE, ZIP):
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NAME:
DAYTIME PHONE:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
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EVENING PHONE:
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
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(Z 5"3 )770
EXPIRATION DATE:
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CONTRACTORS REGISTRATION NUMBER:
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MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): /
`-E "�f S� I a%l� X373 fz'S �7 - 396
RELATIONSHIP TO PROJECT: f f FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE)!/�/r �id,� (•z ) _ ���
,�,/ E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 11 PROPERTY OWNER IIS APPLICANT 11CONTRACTOR
EXISTING USE:
PROPOSED USE:
SPRINKLERED BUILDING?
WATER SERVICE PROVIDER:
SEWER SERVICE PROVIDER:
EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED VALUATION FOR IMPROVEMENTS: $
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES
❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ LAKEHAVEN 11 HIGHLINE 11 PRIVATE (SEPTIC)
❑ NO
A
**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)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
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 INSERTS) RANGE(S) MISC. (, )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
MCCLAIMER/SIGNATURE BLC
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 (including costs, expenses, and attorneys' fees incurred in the
investigation and defense of such claim), which may be made by any person, induding 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 supplieltopie city as a part of this application.
NAME/TITLE: DATE:
❑ PROPERTY R ❑ APPLICANT LY CONTRACTOR
OOMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063.9718.253-661-4000 • FAX: 253-661-4129
www.ckvvffedmlway.com