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Contractor
Electrical Permit #: 02 -101937 - 00 - EL
CATCH 22
ty Development
Conununity Development Services
909 S 336TH ST
3236 168TH AVE NE
3236 168TH AVE NE
33530 1st Way S
BELLEVUE WA 98008
BELLEVUE WA 98008
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
(425)646-7557
Inspection request line: 253.835.3050
Project Name: PUGET SOUND PLASTIC SURGERY
Project Address: 918 S 348TH Suite2 Parcel Number: 114040 0010
Project Description: ELE - Installing a low voltage nurses' call system
Owner
Applicant
Contractor
MONA C/LAURENCE A LUX
CATCH 22
CATCH 22
909 S 336TH ST
3236 168TH AVE NE
3236 168TH AVE NE
KIRKLAND WA 98083
BELLEVUE WA 98008
BELLEVUE WA 98008
(425)646-7557
Electrical Fixtures
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Low Voltage - Other Commercial 1
PERMIT EXPIRES November 6, 2002, IF NO WORK IS STARTED.
Permit issued on May 10, 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. `
Owner or agent: Date: �[ ®Z
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RECEIVED CONSTRUCTION PERMIT APPLICATION
uV �y PPLICATION NUMBER: _
MAY 1 0'/'002 APPLICATION NUMBER:
CITY OF FEDERAL WAY APPLICATION NUMBER:
**The following isN equir information – Please print (in ink) or type**
Please note: Electrical, Fre Prevention Systems and Engineering permits may require a separate application.
ASSESSOR'S TAX/PARCEL #: — — — —
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTAC SEPARATE DESCRIPTION IF LENGTHY):
P(I ()(''' S0()140 IPS n C7/i �/ D /.%P/Fi /-7"r
PR03ECT INFORMATION
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ENGINEERING❑ FIRE PREVENTION SYSTEM
T DESCRIPTION (Provide detailed description):
NAME:
MPERTY OWNER:
NAME:
DAYTIME PHONE:
MAILING (STREET CITY, STATE, IIP):
NAME:,p ��
C: 22
-
(YTIME PHONE:
-
MAILING ADDRESS (STREET AD; CIfY, STATE, ZIP):
EVENING PHONE:
CgY OF FEDERAL W,AYn BBUSINESS LICENSE NUMBER:
FAX N MBER:
C)4
— — — — — —
CONTRACTORS REGISTRATION NUMBER:
— —
EXPIRATION DATE:
(ODPY of card requked)
NAME: DAYTIME PHONE:
r2— /� ( )
MAILING ADDRESS (STREET AD ; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:-
11
UMBER❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
ACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
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: ❑ LAKEHAVEN 0 HIGHLINE 11 PRIVATE (SEPTIC)
t
r
**NEW RESIDENTIAL CONSTRUCTION ONLY**
AV
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
FLOOR
EXISTING . FT.
PROPOSED . 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. SYSTEMS)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILERS) FIREPLACEINSERT(S) RANGE(S) MISC.( )
COMPRESSORS) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
PLUMBING
LAVATORY(S)
RAINWATER SYS.
SHOWER(S)
SINK(S)
SUMP(S)
URINAL(S)
VACUUM BREAKER(S)
WASH MACHINE OUTLET
WATER CLOSET(S)
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
Cher, that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
then agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
restigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the City of
decal Way, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy
the information supplied to the city a; a part of this application.
LME/TITLE: l 2 Q DATE: / 40 V
PROPERTY OWNER ❑ APPLICANT [.CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063.9718.253661-4000 • FA)C 253661-4129
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