02-101383 ( 7
City of Federal Way
Community Development Services Electrical Permit #:02 - 101383 - 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
1110
Project Name: SMITH
Project Address: 30613 9TH S Parcel Number: 174500 0160
Project Description: ELE-Electrical work for the changeout of a 125-amp panel in existing residence.
Owner Applicant Contractor
Wayne&Monica L Smith CLOVER CREEK ELECTRIC CLOVER CREEK ELECTRIC
30613 9TH AVE S 1413 CENTER ST 1413 CENTER ST
FEDERAL WAY WA TACOMA WA 98409 TACOMA WA 98409
98003-4117 (253)627-6648
Electrical Fixtures
Description ;" ] it `�eseription_; Y= Quantity . s : ." Description:",?M ;:^ ",'.[Quantity
Service: -Residential 1
PERMIT EXPIRES September 30,2002,IF NO WORK IS STARTED.
Permit issued on April 3,2002
•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: . ,' Date: V l—
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RECEIVED x
o En >L_ CONSTRUCTION PERMIT APPLICATION
, - \\:.,RpPR 0 3 200Z APPLICATION NUMBER: 0 2 - Lar 3 era 90_ 6Z
APPLICATION NUMBER: - -
C►TY OF FEDERAL WAY APPLICATION NUMBER: - -
ILDING DEPT.
**The folio i g 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: L3 Ili \a aut., ASSESSOR'S TAX/PARCEL#: / 7c(1-712' - O(
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- ■ PROTECT INFORMATION
TYPE OF PROJECT(This application): ❑5.UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
L7 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
C2SL 0- -.Y-cSik
PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME. • Z DAYTIME PHONE: i
MAILING ASDRESS(STREET ADDRESS,CITY,STATE,ZI �—
- QtM S_
CONTRACTOR: NAME" DAYTIME PHONE•
Ci )e.. EA,c `l. c as--5>G2_7? -(44k`i
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP) EVENING PHONE:
14 t C -- ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER. 9.` FAX NUMBER:
•
i at -c Qj t.00c=1, 0 - OC. 22..S (,V7 - (0CR
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE �'
t '2,6\: _k-.
.
x (copy of card required) C LUi 01 O mak-. _ 4 /30 / O''L
APPLICANT: NAME:
v
` ', 1 G , j .�p I�� I PHONE:
AYTIME
n . . 4 ^,,�411 • �.,���J� v )
MAILING AD:•ESS(STREET ADDRESS;CITY,STATE,ZIP): • EVENING PHONE:
11011._.•. \A$ , f N. ' c ( )
RELA ONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ •
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: CILAKEHAVEN ❑ HIGHLINE IITACOMA ❑ PRIVATE(WELL) i
SEWER SERVICE PROVIDER: El LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
k
•
*NEW FiLSIDENTIAL 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: Cl ELECTRIC El 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 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 and employees, upon the accuracy
of the information supplied to the city as a part of this application. J
NAME/TITLE: 1 DATE: <"1l C�
❑ PROPERTY OWNER PPL NT}II"CONTRACTOR
FOR OFFICE USE ONLY:
El NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION _BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
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