04-101223 City of Federal Way
Community Development Services Electrical Permit #:04 - 101223 - 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: MAX PLAZA/PARK ACUPUNCTURE
Project Address: 33100 PACIFIC S Parcel Number: 797880 0180
Project Description: Electrical service conversion from overhead to underground in conjunction with Pacific Highway ROW
expansion project.
Owner Applicant Contractor
CITY OF FEDERAL WAY*MARWAN SALL( POTELCO INC POTELCO INC
33530 1ST WAY SOUTH POTELCO INC POTELCO INC
14105 8TH ST E 14105 8TH ST E
\FEDERAL WAY WA 98003 SUMNER WA 98390 (253)863-0484
Electrical Fixtures
Description Quantity Description Quantity Description ,Quantity
Alt.Serv./Feed 201 amps-600 amps-1 1
PERMIT EXPIRES September 29,2004.
Permit issued on April 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. �r
Owner or agent: See Application Date: _' -2. -04
7— IA -0c 00 c"`:D
Federal Way PERMIT REC 'E�� - _I o L 2._
Z 3
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME`EL PL DE EN FP
33530 FIRST WAY SOUTH•PO BOX 9718 O y �O
FEDERAL WAY,WA.98063-9718 /
253 -661-1115.FAX 253-6614129 P LI C AT I O � 1
Immo dh ofederalwatt.corn
CY OF FEDERAL WAY
The ollowin• is re•mired in ormation-an inco .lete a..lication urITal�� ® L , T� p� ,1 int Ie.ibi (in in or
PROPERTY INFORMATION
•
SITE ADDRESS \O� \S--4.--C V-‘3....‘,....3_ #
ASSESSOR'S TAX/PARCEL# /7 7 D O 1-R-0 LOT SIZE(s.0LEGAL DESCRIPTION(e.g.Acme ESO s,Lot 1)
(Attach separate page for lengthy legal desmpnon)
PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING O MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed des
'tion of work included on this permit only)
ic_e C.c,rl c -ci oil fro-- Cc ,er-ke ad 4t, unde roc_t -
PROJECT NAME(Name of Business or Owner Last Name) '("�( UeV -z /,u,,,, (kbe,,,
PEOPLE INFORMATION
PROPERTY NAME' A - {� rP�R71MARY PHONE
OWNER iv`UCc�X�In cQV`(]c,c(Y1 cY Q(t^-�� I R )l"oN i -� ��
MAILING ADDRESS CITY,STATE,ZIP
-3.2-,S30 `r� �.. sem,, I \C .c�� G�G�
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
(2C)ae\c.o '--""at-)c_ Qki.cscY- t -ec-.3 i (ZS?) K3 -04 4'
MAILING ADDRESS
F%\-,
`� CITY,STATE,ZIP CELL PHONE
14�^
5 Zy ai-- _ So ,CAJA Geo win-76C -c>13‘
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBERGEXPIRATION DATE FAX NUMBER
20-o ‘ - k o t S 7 - BLL 12 / 31 / Cf.4 (253 ) F63 -C3--9
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
9 cr-v-cz L^�._ 4( 3 4 4 G � S--- / 3 i / G S--
APPLICANT CAIPANY NAME APPLICANT NAME 1� OFFICE PHONE
a e\c o��n c 0��Uet- t-'�1-,cn e r (253 )(96"'" -C(4
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
tit C.f ‘• SNr. `r= Scxv,rar-,C• Cl Seo (La T7 7(( -0\36 _
RELATIONSHIP TO PROJECT Cr FAX NUMBER
0 Architect ❑ Tenant ❑Agent VNOther(Describe) (2 S"3) JO 3 -e--/C(
CONTACT N -
C4j 4 � PRIMARY P25 E-MAIL ADDRESS \
t�,er !/'\W.„[,. 3 as-3 111 G("6 -Cc-W(1 Cx'i►Yi cac,�,Q�J�a�Aco.r") .\-
LENDER PerRCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
. . DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES a NO
WATER SERVICE PROVIDER O LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLO VIi t-ARFAS
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 PROPOSED TOTAL EXISTING AND PROPOSED
"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(coranmc 1) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Descnbe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS or rub/shouerCombo) SHOWERS WATER CLOSETS(Toth q 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, 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 ma. by any person,including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the reliance o e c• incl •ing its fficers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE 44/(10(1
( Ignature) (Ti )
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect Other SA'",03I_'e\�—C'0 -
FOR OFFICE USE ONLY
❑NEW a ADDITION a ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—March 30,2004 Page 2 of 4 k\l iandouts—Rcviscd\Permit Application