04-105194 4
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City of Federal Way
Community Development Services Electrical Permit #: 04 - Bb194 - 00 - EL
P.O.Box 9718
FederalWay,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305C
Project Name: PEREZ
Project Address: 30404 21ST1SW Parcel Number: 122103 9094
Project Description:, Change 30-amp circuit to 50-amp circuit to serve range.
Owner Applicant Contractor
Fred R Perez &Peggy A Perez HOLMES ELECTRIC HOLMES ELECTRIC
HOLMES ELECTRIC HOLMES ELECTRIC
PO BOX 179 PO BOX 179
RENTON WA 98057 (425)235-8000
Electrical Fixtures
�65%,l ration ftQuantity Description Quantity Description Quantity
Circuits-Residr 1i di 1
PERMIT EXPIRES June 25,2005.
Permit issued on December 27,2004
I hereby certify that the above information is correct and that the construction on the above ascribed property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the*It: of Washington and
the City of Federal Way.
Owner or agent: ..J /1 107-0 Date: I 2----/Z? / �f
I [4(0S l r oo0 i'c
D
o`'
4457
THIS CARD IS TO REMAIN ON-SITE ,
CITY OF , Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
•PERMIT#: 04-105194-00-EL
Owner: FRED R PEREZ
Address: 30404 21ST AVE SW
FEDERAL WAY, WA 98023-2306
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Slab/Concrete Floor(4255) 0 Ditch cover(4030) .❑ Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) t❑ Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
O Rough Electrical(4225) ;3 Ceiling Cover(4020) ►�41 Final-Electrical(4055)
Approved Approved Approved
,,
By Date - By Date B `i‘iI Date r
O Under-slab groundwork(4295)
Approved
By Date
RECEIVED!
Federal Wayej0. _. - L c2_ _L_a_q_
aoMMUMTYDEVELopmENrsERyiCES PER M I ( 2 7 2004
SF MF COM
$33530 FTRST WAY SOUTH•PO BOX 9718 EL 'L DE EN FP
FEDERAL WAY,FAX
98063-971841A p p LI C A� ,I 1
FEDERAL
WA 66ERAL WAY ° / /www'a`t"ff`d`�°'°°'°°'" BUILDING DEPT.
The ollowt • is re,aired in orrnation-art Inco .lete a e.iication will not be acce•ted. Please ,rint Ie•ib( in ink)or
PROPERTY INFORMATION '
SITE ADDRESS 3 X4QtA a\c c (� w 1
' vL ` �l•�� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL Y -
LOT SIZE(si)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy lewd daaipian)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION rgLECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Ct\-RoC' ZAOA_ (ail.CLOS iT SD Puytp &2r,i 2i
�)��L%r �1
PROJECT NAME(Name of Business or Owner Last Name) FOA RL C—F--
PEOPLE INFORMATION
PROPERTY NAME ���111
OWNERS 1' O y�y� PRIMARY PHONE
(�(� �j
MAIUNG ADDRESS 1 l CITY,STATE,ZIP ���+ _f/I4s/�
50 Li 0 a (4,ST `li"V E 5c..,3 T1-DE- 11. L'j1,0/4 �'
1
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE/ PHONE
1AOLm , IJ1-I.L ' )Mr 1-70).3( L/"7J 7- -Beek,
ILING ADDRESS STATE,ZIP
Q. v� /n,' ]((� CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER a3P �I l DATE ( ` 1
(� N EXPIRATION FAX NUMBER
2Q-.00-1 Q 1 J 1 - B L / 31 b(� (q ) "//(�
CONTRACTOR'S REGISTRATION NUMBER(coPy of ccardreequired with each application,
E' D L 16 S� c _ . -F i1 b- /,,,EXPIRATION DATE
go
APPLICANT COMPANY N MENw( �V)
S\ APPLICANT NAME /OFFICE PHONE
HtniuNG ADDRESS `
CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT
a Architect a Tenant a Agent 0 Other(Describe FAX NUMBER
CONTACT I NAME I PRIMARYP HONE -
1! i E-MAIL ADDRESS
LENDER Per RCW 19.27.095: Lender information is NAME 1 i
required ijproject value exceeds$5,000
MAIUNG ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE
PROPOSED USE
•
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? p YES ❑ NO
WATER SERVICE PROVIDER ❑LAKEHAVEN o HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
• AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
r BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL BASTING AND PSOPOSI
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) W OODSTOV ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES _ GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(roikt) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
_ GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks)
VACUUM BREAKERS ELECTRIC WATER HEATERS
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, t
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to
harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defen
such claim), which may be made by any , son,including the undersigned,and filed against the City of Federal Way,but only where such 4
arises out of the reliance of the city,Inc u..;ng its officers and employees, upon the accuracy of the information supplied to the city as a pc
this application.
NAME/TITLE V �' DATE I�V v�o.-0:9Gf/
(Sig ire) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Ag.nt es Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
o NEW a ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? o YES a NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? o YES o NO
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Bulletin#100-March 30,2004 Page 2 of 4 • k\Handouts-Revised\Permit Applit