02-100232 of
CityFederal way
Community Development Services Electrical Permit #:02 - 100232 - 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: LIFE CARE CENTER OF FEDERAL WAY
Project Address: 1045 S 308TH Parcel Number: 082104 9042
Project Description: ELE-Replace electrical genereator.
Owner Applicant Contractor
FEDERAL WY CONVALESCENT C*FEDER GENER8R CONTRACTORS INC. GENER8R CONTRACTORS INC.
PO BOX 723548 GENER8R CONTRACTORS INC. GENER8R CONTRACTORS INC.
ATLANTA GA 31139-0548 PO BOX 66070 PO BOX 66070
SEATTLE WA 98166 (206)575-3091
Electrical Fixtures
Description Quantity Description AQuantity Description !Quantity
Service/Feeder:101-200 amps-Coma 1
PERMIT EXPIRES July 16,2002,IF NO WORK IS STARTED.
Permit issued on January 17,2002
• 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: '26/QC Date: / 1/ 7 /l7'-L
2 _ z' — o z.
P
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•71/
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CONSTRUCTION PERMIT APPLICATION
\>\> APPLICATION NUMBER: D.2.-/ 0 0 2 Z- 0 a
APPLICATION NUMBER: - -
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: IO 7 S so. je ASSESSOR'S TAX/PARCEL#: 1) % 21 D( - 10 Z
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
:'�: :i . .: -. ■ PROTECT INFORMATION - - - - . . _
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING -14€C1IANICAL ❑ DEMOLITION
,ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): T - -r = _ _ ' • _
4ka Ct Geyve,roticer
PROJECT NAME: L)FE. C-4M. CeAr o,ci�OeAL way
_ - ■: PEOPLE INFORMATION ;' ;-:-.
PROPERTY OWNER: NAME: DAYTIME PHONE:
LICE cm-42- ceNT1L 0‘) -1 (243 ) 9yL -2Z7S
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
GENIC-11'9A Co ti r-Oro,t , 3c (2.06 )57S - 309
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
Po go1( 66070 Sz q-s -t,E Ly 9'431 66 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: " FAX NUMBER:
/��- - (21-16 )6.23 - y/or
CONTRACTOR'S card required)
NlJ � s '�7F/ ERC/ 023 01<8 EXPIRATION DATE: /2-4.10O 3
(copy of 3 t
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:ONE:
( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ACONTRACTOR
• ■ .DETAILED BUILDING INFORMATION = -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 3 2-00 .'
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ 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 ❑ 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 to the city as a part of this application.
NAME/TITLE: L\ObtA1l" /V RPtCII_ /CCP")es/L.Al. M/1". DATE: /46434/
❑ PROPERTY OWNER ❑ APPLICANT [CONTRACTOR
-
'FOR OFFICE USE ONLY: -
#❑zNE{N V__ - ❑ADDITION --❑ALTERATION = :=❑;REPAIR- --- ❑TENANT IMPROVEMENT
,CENSUS;,CODE: _ -- - - - - - • `LOTSIZE:x :: . .. r -
ZONINGp'ESIGNATION:< _ BUILDING SHELLI.ONLY?: ❑YES ❑ NO • ,
vCUMPIEPLAN'DESIGNATION BASIC PLAN?_''❑*ES" 0 NO'
SECTION ==Y (TOWNSHIP RANGE • - _NEWADDRESS REQUIRED? • ❑ YES -❑.NO •
;PLATTED'LOT? _ -❑YES ;❑NO CHANGE AF-USE?. _" -❑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