02-102164I • 1
City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Electrical Permit #:02 -102164 - 00 - EL
Project Name: BELMOR MOBILE HOME PARK SPACE 11
Project Address: 2101 S 324TH
Project Description: ELE - Replace meter pedestal for mobile home - SPACE 11
Inspection request line: 253.835.3050
Parcel Number: 162104 9037
Owner
Applicant
Contractor
BELMOR HOLDINGS LTD
SHEPPARD & NELSON ELECTRIC
SHEPPARD & NELSON ELECTRIC
1571 BELLEVUE AVE W SUITE 210
PO BOX 3630
PO BOX 3630
VANCOUVER CN
KENT WA 98032-0210
KENT WA 98032-0210
(206) 878-7333
Electrical Fixtures
Service or Feeder - Manu./ M.H. Park 1
PERMIT EXPIRES November 19, 2002, IF NO WORK IS STARTED.
Permit issued on May 23, 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, rules and regulations of the State of Washington and
the City of Federal Way. See ApiDlication
Owner or agent: Date: ✓ O
a" or G_ ; CONSTRUCTION PERMIT APPLICATION
uVEI L PPUCATION NUMBER:
fAPPLICATION NUMBER: - _ (APPLICATION NUMBER:
NUMBER:
CITY OF FEDERAL WAY—
**The following is r6U&@jNQcftPg9n - Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS:3rd Y ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION Provide detailed description):
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PROJECT NAME: r1�ltJy- ��`.
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
NAME: �
I // DAYTIME PHONE:
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MUNG ADDRESS (STREET ADDRESS, 'ATE, ZIP).
dl s, aY t--�'!i-_ 5'003
NAME:
DAYTIME PHONE:
(a06) SSS
-73 33
MAI G ADD (STREET ADDRESS; CITY, STATE, ZIP):
PHONE:
(E`VENING
EFUNEDERAL Y BUSINESS UCENSE NUMBER:
FAX NUMB:
CONTRACTORS REGISTRATION NUMBER:
EXPIRATION DATE:
NAME:
MAIUNG ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROTECT: F NUMBER: -
❑ ARCHITECT 1:1TENANT ❑ OTHER ( DESCRIBE):
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ACONTRACTOR -
DETAILED 13UILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 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:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCTS) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTORS) 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 syp4ied to the city as akart of this application.
NAME/TITLE: L�/�/./ �i-7L ^ DATE: . / D �---
❑ PROPERTYOWNER ❑`CPPLICANT ❑ CONTRACTOR
ODMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO 13OX 9718 • FEDERAL WAY, WA 98063-9718 •2S3.661-4000 • FAX: 2S3.661-4129
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