04-100115 City of Federal Way
Community Development Services Electrical Permit #:04 - 100115 - 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: 7-11
Project Address: 104 SW 312TH .54" cel Number: 072104 9219
Project Description: Alteration to extend 120v circuit in backroom
Owner Applicant Contractor
7-11 SOUTHLAND CORP. MADSEN ELECTRIC ELECTRIC
104 SW 312TH ST 3939 S ORCHARD ST S ORCHARD
TACOMA .6 TAC A WO%
\FEDERAL WAY WA 98023 (253) -45
Ele =I Fixtures
Description [quantity Descrip Quan esc ion Quantity
Circuits- Commercial WEI
(110
PERMIT EXPIRES July 12,2004.
Pe ' sued on Ja ary 14,2004
I •- - 'Ty that e ormation is c and\ Østructiona on the above described property and
p. • and the use '1in accord s and regulations of the State of Washington and
ity • deral Way. IF / /
• . or age I it Date: `�
�� it ?`t.o d CONSTRUC I ION PERMIT APPLICATION
CITY OF �� APPLICATION NUMBER: pg - _1 _00 _11 -- co
Federal Way 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: /0 -T Sv a
� 3lZ ASSESSOR'S TAX/PARCEL #: -
U
q �V
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): / '
- T. . - - - . ' - , , • - -- • PRO]ECT INFORMATION ' -" -
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MECHANICAL 0 DEMOLITION
ELECTRICAL o ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT D CRIPTION(Provide detailed description):
fol. ✓ 10-2-- der.
PROJECT NAME: 7-
' • PEOPLE INFORMATION
PROPERTY OWNER: NAME: ; DAYTIME PHONE
( ) -
MAIUNG ADDRESS STREET ADDRE ;CITY,STATE,ZIP):r--
/D q -54) 3/G2
CONTRACTOR: ( NAME: I DAYTIME PHONE.
w191)sem c /e a'7' : 2 ! (-x6-3) 32-3 -4-s-4 7 4,
MAILING ADDRESS(STREET ADORE CITY,STATE.ZIP): EVENING PHONE-
.
.313 S SZ gc.4 met> ( ) s,s-u.ti _
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
147- '/tel(-53-vQ s4e L_ ; us-3 ) s..Af-[po'/
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(copyof card required) W1 L $ E E_ L "Lb_ P$ _ i 3 /-2:7 / 0 q
APPLICANT: ( NAME: '. DAYTIME PHONE-
-14-4446-7 t4 CiC.9N O� ( )
MAILING ADDRESS(STRE.E4DDRESS;CITY,STATE,ZIP): EVENING PHONE
� ( ) -
I
RELATIONSHIP TO PROJECT: j FAX NUMBER.
o ARCHITECT o TENANT o OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER o APPLICANT kCONTRACTOR
•■ DETAILED BUILDING INFORMATION 0 -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES o NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)