02-100618 sf_a-
City of Federal Way
Community Development Services Electrical Permit #:02 - 100618 - 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: NORTHWEST CHURCH 21ST&348TH ST
Project Address: Parcel Number: 122103 9087
Project Description: ELE-Install traffic signal @ 21st AVE SW&SW 348th ST.
Owner Applicant Contractor
CITY OF FEDERAL WAY SIGNAL ELECTRIC SIGNAL ELECTRIC
CITY OF FEDERAL WAY PO BOX 6209 PO BOX 6209
PO BOX 9718 KENT WA 98064-6209 KENT WA 98064-6209
FEDERAL WAY WA 98063 (000)872-7177
Electrical Fixtures
Description ; Quantity Description Quantity Description Quantity
Service/Feeder: 0-100 amps-Comm. 1
PERMIT EXPIRES August 6,2002,IF NO WORK IS STARTED.
Permit issued on February 7,2002
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,acerdance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: %/�%� Date: 472.
SLE
;V'Of CONSTRUC 1 ION PERMIT APPLICATION
EEI SAL
APPLICATION NUMBER: 0 2- Q 6 2--
uv FIY
APPLICATION NUMBER: - -
4- 3500 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: 21St Ave. SW & SW 348 Street ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
Northwest Church @ 21ST Ave. SW & SW 348 Street , city of _Federal Way.Traffic Signal
• - ti = = • , ■ PROJECT INFORMATION • . . -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
® ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
Install Traffic Signal @ 21st Ave. SW & SW 348 Street, City of Federal Way
PROJECT NAME: Northwest Church, 21 cr Ave_ SW & SW 348 Street
- ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
City of Federal Way ( 253 ) 661 - 4000
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
PO BQx_ 9718,Federal Way_ -WA 98063
CONTRACTOR: NAME: DAYTIME PHONE:
Signal Electric, Inc. ( 253 ) 872 - 7177
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
PO Box 6209, Kent , WA 98064-6209 ( 206 ) 510 - 5218
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
9 9 — 1 0 7 2 7 6 - 0 0 ( 253 ) 395 - 0556
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
�,(copy of card required) e m. SILE _AL 07 / 01 / 2002
APPLICANT: NAME' DAYTIME PHONE:
Signal Electric. Inc. ( 253 ) 872 - 7177
MAILING ADDRESS(STREET ADDRESS,CITY,STATE,ZIP): EVENING PHONE:
PO Box 6209, Kent . "WA 98064-6209 (206 ) 510 - 5218
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ® OTHER(DESCRIBE):Sub-Contractor ( 253 ) 395 -0556
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR SIGNALELECTRIC@EMAIL.MSN.
COM
- - ' - •V -_ - 1 DETAILED BUILDING INFORMATION ' • V -" -
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 El HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• •
- ■ PROTECT 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: ❑ ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC 0 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 claim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,including 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 to the city as a part of this application.
NAME/TITLE: I' ♦ C_f2& DATE: 2/6/2002
Craig 011er, Pr. ject Manager
❑ PROPERTY OWNER ❑ APPLI4 T ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW - -: • 0 ADDITION 0 ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
„ZONING DESIGNATION: BUILDING SHELL-ONLY? 0-YES- " 0 NO
COMP-PLAN DESIGNATION BASIC PLAN? AOYES ❑ NO _ I.
-SE'CTION_ = • TOWNSHIP RANGE NEW ADDRESSREQUIRED? - 0 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.citvoffederalway.com