02-100625 r-
City of Federal Way
Community Development Services Electrical Permit #:02 - 100625 - 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
411
Project Name: LADY OF AMERICA FITNESS
Project Address: 1614 SW DASH POINT Parcel Number: 122013 9074
Project Description: ELE-Service changeout and tenant improvement. Changeout 200-amp for 400 amp,relocate light and
add outlet.
Owner Applicant Contractor
AUDREY/SYDNEY IRMAS CHARITABLE F( KIRBY ELECTRIC INC KIRBY ELECTRIC INC
20206 72ND AVE S 1519 WEST VALLEY HWY SUITE 102 1519 WEST VALLEY HWY SUITE 102
KENT WA 98032-2322 AUBURN WA 98001 AUBURN WA 98001
(253)804-6756
Electrical Fixtures
Description: (Quantityi : Description -- (Quantityl -4" h ; ,Description (Quantity
Service/Feeder:201-400 amps-Comr I
PERMIT EXPIRES August 7,2002,IF NO WORK IS STARTED.
Permit issued on February 8,2002
•I hereby certify that the . . 1 ve information is correct and that the construction on the above described property and
the occupancy and the - '11 be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal W. / /
Owner or agent: / _`J Date: t — — ti Z
2 - l°I -- O - wc.,\\S . L Q ov y .-:5 •
2 - 7..6,- p z Ser u c e- $' S.e r v tc-a_ e.n., : #1......A4 0.-k. v k tri- 1:20.e-14'Qi.t -�S _
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RECEIVED
ar•« G_ CONSTRUCTION PERMIT APPLICATION
EJIZFI
N>N> F3y i__ FEB 0 8 2002 APPLICATION NUMBER:O - -1OD(ZZr-40-gam
APPLICATION NUMBER: - -
CITY OF BUILDING FEDERAL
APPLICATION 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.
- - - " - ■ PROPERTY INFORMATION ' - - - - -
SITE ADDRESS: 11.01q i?6bt 420,--,..4- Ind ASSESSOR'S TAX/PARCEL #: Le--Z/' 3 -et q 7 c
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
1
.'- •,••.,'‘C -.--.-> -:-_ - -.-; .--- , ■ PRO3ECTINFORMATION - - - . - -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL Cl ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 5olevi Le- cka,..,G L 4- -I-..„A.„.4--
- 1- _sp _ re to e...4.4._.
PROJECT NAME: &A-1)1/ C ?J4 7i(GJ.y
- ( ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME:
DAYTIME PHONE:
MAIUNG ADDRESS EET ADDRES�,STATE,ZIP):
CONTRACTOR: NAME. f DAYTIME PHONE:
y ( �- J-r.c_ (Z53)8b�( -G-1 s<
MAILING ADDRESS(STR ADDRESS-CITY,STATE,4])I,: EVENING PHONE:
l' I°t a" L v ul ui.. 0 1 DZ (253 ) 60� -6035 ,
CITY F FEDERAL WAY BUSINESS ENSE NUMB FAX NUMBER:
a4.-- G It '- at 1,2 l a 1 8 -7 O a (`is3)8oy - (-s31
CONTRACTORS REGISTRATION NUMBEXPIRATION DATE:
(copy of card required) Kt Hay 6�-773 Al �� ► / l 5-/ 03
APPLICANT: NAME: DAYTIME PHONE:
<',',4 / ( ) -
MAILING ADDRE�S(STREET ADDRESS, ,STATE,ZIP)- EVENING PHONE:
. ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT Cl TENANT ❑ OTHER(DESCRIBE): ( ) -
I E-MAIL ADDRESS:
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: $
1 SPRINKLERED BUILDING? ❑ YES Cl NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO ~
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE Cl PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
• - ■ PROSECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS? _
TOTAL:
■ FIXTURES
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)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 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 .armless the City of Federal Way as to any daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and d• se of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but • ere such daim arises •ut of - reliance of the dty,induding its officers and employees,upon the accuracy
of the informatio ..lied to e . s a p. •f ■; .plication.
NAME/TITLE: i4 DATE: t b 2
❑ PROPERTY OWNER ❑ APPLICANT ' •NTRACTOR
FOR OFFICE USE ONLY:
F❑.NEW• ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑TENANT-IMPROVEMENT - -
CENSUS CODE: __ _ LOT SIZE:
,ZONING DESIGNATION: - BUILDING SHELL ONLY? 0 YES 0 NO
:COMP-PLAN DESIGNATION BASIC PLAN? : ❑ YES ❑ NO
SE'CFION_, TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES 0 NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? 0 YES 0 NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtyoffederalway.com