02-102983 (,ty of Fereral Way
Community Development Services Electrical Permit #:02 - 102983 - 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: CHAVEZ RESIDENCE
Project Address: 4260 SW 331ST Parcel Number: 327905 0010
Project Description: ELE-Temp power
Owner Applicant Contractor
Martin&Dawn R Chavez Martin&Dawn R Chavez NONE
33400 28TH PL SW 33400 28TH PL SW
FEDERAL WAY WA FEDERAL WAY WA
98023-2744 98023-2744
Electrical Fixtures
Description ,' m ,; Q ty , ;>Descriptian.:j .:. Quanti r °. :;' 1_Description : ' . Quantity
Temp.Service up to 100 amps-Res. 1
PERMIT EXPIRES January 11,2003,IF NO WORK IS STARTED.
Permit issued on July 15,2002
•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: 7-
-
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RECEIVED
;r . CONSTRUCTION PERMIT APPLICATION
V�1 y — JUL 1 5 2002 APPLICATION NUMBER: Q d.- / Q 2 2 "
APPLICATION NUMBER: -
CITY OF FEDERAL WAY _
APPLICATION NUMBER: - -
BUILDING DEPT.
**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.
/ ' - ■ PROPERTY INFORMATION
SITE ADDRESS: 4�v 5u) 33 S 1p 1 ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.■ PROJECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL ❑ DEMOLITION
I ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): ( --�� e9 - e._ L 1
PROJECT NAME: 0.....1/\AV't--Z- "R - a- L+
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
t CAN Vi- ltz (ns )33Z.- 19'43
MAILING ADDRESS(STREET ApDRESS;CITY,STATE,ZIP):
3340+0 2 .
CONTRACTOR: NAME:
DAYTIME PHONE:
0 IN' j e z C___,CY.'-4/c- cJ-S " --' (z5 33r__- ;, /3
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): . EVENING PHONE:
33 II &o 7._1‘`F`` • 6 w (`zs 3) Ss7`r 50 4`]
CITY OF FEDERAL WAY BUSINESS LICE NUMBER:
11C-
t FAX NUMBER:
^ C-0"C12-14 - - ( ) -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) 'L'- Il- ,4- V c--C4€ (Q , / /< ,G a s / c—t4 / z 00`-e
APPLICANT: N{A/(MME/:: DAYTIME4 PHONE:
MAILING ADDRESS CITRATE,ZIP): ( G ) �3 Z - !9 Y..s
EVENING PHONE:
5 4 Oo TC. Scv (zsc) F-?W - 9/6,7
RELATIONSHIP TO PROJECT: p / FAX NUMBER:
1:1 ARCHITECT CI TENANT MOTHER(DESCRIBE - , - ,p /c° ( ) —
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 14 PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT 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 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)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) 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.( )
INTERCEPTOR(S) 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied - e d as a part of this application.
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NAME/TITLE:' ty • Yl DATE: 7-i`.)^--c;
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€ pl,PROPERTY OVCNER AAPPLICANT -CONTRACTOR
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gEcI ON 'TOWNSHIP t,r;RANGE _,"_-_ ?s;NEW ADDRESS REQUIRED? �:` .1 = IES" �YNO;
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COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvotTederalway.com
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