04-100078 City of Federal Way
Community Development Services Electrical Permit #:04 - 100078 - 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: JACK IN THE BOX
Project Address: 2400 SW 336TH 5 Parcel Number: 132103 9110
Project Description: Wiring for new satellite dish installation. Dish dimensions are 3.25'x 1.5'x 4'high,to be screened by
existing 5'parapet wall.
Owner Applicant Contractor
JACK IN THE BOX INC AMSAT COMMUNICATIONS LLC AMSAT COMMUNICATIONS LLC
8909 SW BARBUR BLVD SUITE 250 5537 CHEYENNE LOOP RD ROOM B 5537 CHEYENNE LOOP RD ROOM B
PORTLAND OR 94219 TACOMA WA 98409 TACOMA WA 98409
(253)905-8128
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Low Voltage-Other Commercial 1
PERMIT EXPIRES July 7,2004.
Permit issued on January 9,2004
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 Wass''gton and
the City of Federal Way.
Owner or agent: , Date:
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CITY OF COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 97115
Federal way - PERMIT APPLICATION FEDERAL uA•Y,WA ,9';
m+t- h nla-ae c xn
Fay oma«u«oay: FW File Number: Q — - 1 Q D d � O - L TD:
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' The olio • is -• fired in ormation-an inco •tete • •.lication will not be acce•ted. Please •rant le•ib• in ink)or J•
■ PROPERTY INFORMATION
SITE ADDRESS: ()quo S Cu 31 • .r ASSESSOR'S TAX/PARCEL#: ( 3 Z.4_ 03 - 7 / 1_ 0
LEGAL DESCRIPTION(eg:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
SQUARE FOOTAGE OF LOT: ,—^
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): ❑ BUILDING 0 PLUMBING ❑ MECHANICAL Cl DEMOLITION
p'ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only): Rus-r-4 I L. - c cmit Eie e(l
ti.s4,.
3 t " x l8 `' X `lg `(j ,
PROJECT NAME Name 0 Business/Owner Last Na z.• Sc- -- I (n, - 1 - — B. a
■ PEOPLE INFORMATION
PROPERTY NAME: !� PRIMARY PHONE:
OWNER S T�✓ c �0/(�(:C/ 1C,$T I K. 1"y' ( ) -
MAIUNG ADDRESSS d)? reri(STREET-6,0.0U 5 elk 6 Z vi) C .,..STATE,
lV-0 `� q 7'2/9
CONTRACTOR: NAME f/'`+( �('jj COMPANY OFFICE PHONE:
s4Nis4f Cdr LLC ( ) -
MAILING A DRESS(BYRE A ESS;: CITY,STATE,ZIP CELL PHONE:
f�'Y7 c �� � 7'/� c o�>�i �i,¢ Q$'4 ( ? 3 ) CSS' - /�$
CITY OF FEDEWAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: F/AX NUMBER -
/ /
CONTRACTORS REGISTRATION NUMB R EXPIRATION DATE:
(copy of card required with each app cation) h i4 .5 A r G q Y I L -r v 6 / /.2 /O2 O f
LENDER NAME: (DAYTIME P HONE: -
(It rrep«e1 Vane>$5,0001
MAILING ADDRESS(STREET ADD ;): CITY,STATE,ZIP
APPLICANT: NAME: r`^'V—1 1 <=-�� COMPANY OFFICE PHONE: -
liir
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
(
RELATIONSHIP TO PROJECT: FAX NUMBER: '
❑Architect ❑Tenant 0 Other(Describe): ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner \ 9,( ..._ actor 0 Applicant E-MAIL ADDRESS:
■ DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED•
�EIVrD
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: Cl LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC) JAN 0 9 2004
CITY OF FEDERAL WAY
BUILDING DEPT.
■ PROJECT FLOOR AREAS •:
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
-THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING ,,;,,TOTAL raoeosm • !a[AI Elasrt IOAND raorosrD Ft;
£ f-,g • •..c' � , ` -FY"'.� :h3:, b
**NEW HOMES ONLY`* NUMBER OF BEDR•• S: E 'MATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is to be install- or rel s ed as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIV OOLERS GAS LOGS REFRIG.SYSTEMS
s BBQS FANS •MOODS WOODSTOVES
BOILERS FIREPLAC NSERTS RANGES MISC(Describe)
COMPRESSORS FURNAC • AS WATER HEATERS
DUCTS GAS PIP OUTLETS _
PLUMBING
BATHTUBS(or Tub/ShowerCombo) SHOWERS WATER CLOSETS(Toile) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAYS(eumoomsink 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,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 claim), which may be made by any person, including the
undersigned,and filed against the City of Federal Way, but only where such claim arises out of the reliance of the city,
including its officers d 1 upo he accuracy of the information supplied to the city as a part o this plication.
NAME TITLE: � '( S DATE: /
y
(Signature) (Title)
RELATIONSHIP TO PROJECT: o Property Owner 0 Applicant fe Contractor 0 Architect 0
•
• • • •SE;ONLY. 'L
••
" ;», � 1lDD�ITION'=; :ALTERATION x *:4_r a REPAIR S j ``>- M�;t'a TENAl!iTcIMPRO EMENT ,� ' A€>'
BIIIL�ING�SFIELL 1!iLY? : PES O ``_•'_# , X BASICxPLANZ.' `' •:(e'' •r *�'�'7'°#..2 YES 'NO-�'M
x;ZONING 5 ESIGGN VI ON;,' =='i< ',' `. to r Z "" *r r: a". ',,;-,x, r• .. x
-.-.-, _.. . .. �.v:k'iit+^:
- a ,.:
cNEW DDREESS'RF,QUIRED?'
t "a-its•`;•a NO-` DEMO-PERMIT REQUIRED. o YES -'1':`j-No',';