04-100010 City munitederal Way
Community Development Services Electrical Permit #:04 - 100010 - 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: BOMAN
Project Address: 30528 5TH SW Parcel Number: 178890 0380
Project Description: Change panel(not meter)
Owner Applicant Contractor
REBEKAH BOMAN CHIN'S ELECTRIC CHIN'S ELECTRIC
30528 5TH AVE SW 33530 13TH PL SW 33530 13TH PL SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)405-3348
Electrical Fixtures
Description Quantity Description Quantity L Description 'Quantity
Alt.Serv./Feeder:0 to 200 amps-Res. 1
PERMIT EXPIRES June 30,2004.
Permit issued on January 2,2004
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: Date: Z
/— 9_ Q y o jf - '
` RECEIVED CONSTRUCTION PERMIT APPLICATION .2
CITY OF APPLICATION NUMBER: - _
Federal Way DEC 3 0 ?nnR APPLICATION NUMBER: Qm - L 00010- 00
(APPLICATION NUMBER: -CITY OF FEDERAL WAY
**The follov rig I[ gmi!3 hrp Ormation-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
- _ = • - , ■ PROPERTY INFORMATION • - ,_
SITE ADDRESS: 03Zn /94-e 36" ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
4
-. _- -- • PROJECT INFORMATION - _
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 MECHANICAL 0 DEMOLITION
' ELECTRICAL 0 ENGINEERING o FIRE PREVENTION SYSTEM
•
PROJECT DESCRIPTION(Provid detailed description):
P0-41 afr-kit Ovef -i-e-*-17
ii
? PROJECT NAME: ilC)gV t\1V
_ - . • ■-PEOPLE INFORMATION • : - .
I"
PROPERTY OWNER: NAME: ‘R DAYTIME PHONE' -
( )
MAILING ADDRESS(STREET ADDRESS; Y,STATE,ZIP):
CJT
3os 2g? s 4,e Sc
11
CONTRACTOR: NAME: r S DAYTIME PHONE:
It MAIC i ���r/�J 1 ; (Z$�3) ls.-- 331
LING ADD S(STADOES
REET R ;CITY,STAYS,ZIP)• 1 EVENING PHONE*
' 3 ss—o t 3' PC ( so ! ( ) -
I CITY OF FEDERAL WAY BUSINES LICENSE NUMBER: FAX NUMBER:
1. 0 - - (7 ) e7 -:sW/ I
CrRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
i APPLICANT: NAME: DAYTIME PHONE•
ee(9 iii MAILING
`)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE' -
i
RELATIONSHIP TO PROJECT: j FAX NUMBER.
o ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( ) -E-MAIL ADDRESS:
I ;
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER 0 APPLICANT D CONTRACTOR
- -,. - - - . . -■ DETAILED BUILDING INFORMATION - -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
1 PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN o HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT 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 Value of Mechanical Work: $
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERTS) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o 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 dty,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE: DATE: I/2/67"
o PROPERTY OWNER o APPLICANT 7b-EONTRACTOR
_,FOR.OFFICE USE ONLY:
- � � , p ADDITION Y .;`Q ALTERATION ,'.f3 EPAIR' ;F v fl;TENANT IMPROVEMENT;
CENSUS`CODE:';.5-; xqN= _ -w'. - � ': = - <: :3-
_=� .: -r � �_. -- -LOT SIZE:='r=��:,w- -;;.��=nor,�,: - ��a�:.r.-�;• _•, _ ,-•?=
:ZONINGTDESIGNATION ;F ;L -.E; :BUILDING SHELLyONLY? BYES�'�:o NO
COMP PLAN DESIGNATION,' = �:� _,= ;i rBASIC PLAN?- o YES' ';❑NO;E '* ='
-SECTION •y T0INNSIiIP:`' ;`RANGE'.i1-Vt' AENVxADDRESS REQUIRED?-`- :•"o YES a NO' •
-.PLATTED LOT?;.=';''o YES'' o'NO •''r rz"r 3 `:z: •'CHANGE OF USE7•` =``= ❑YES'F`:fl NO.- ..' ". '
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvofederalway.com