04-101216 f w
City of Development Services eveWay
Community Electrical Permit #:04 - 101216 - 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: SECOMA VILLAGE
Project Address: 33320 PACIFIC S Unit108 Parcel Number: 797820 0025
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
141058TH STE 141058TH STE
\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
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.
Owner or agent: See Application Date: `f L '°y
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Federa�wy PERMIT _a� - I `_ J_ �-�
COMMUNDYDEVELOPMEN'SERVICES
SF MF CO ME EL PL DE EN FP
33530 DR A WAY SOUTH• BOX 9718 A P P L I C AT I CGEN
FEDERAL WAY,FAX
98063-9718- 1-4 / /
?53-661-1175•FAX 25361-1129
unuw.dtuofederalwou.com yy //��
The ollotoin. is re•wired in ormation-an incom•lete a.•lication ! it:*tO,elaa7 -fled. Please •tint le.ibl (in in or
PROPERTY INFORMATION
SITE ADDRESS 3 33 2-0 —Pak.,i-c-C. ( 1,0 TY ODERAL WAY
B��F�El DFPT SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 767 I R- dC- O _ - , LOT SIZE(sJ)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate pogo for lengthy legal description)
PROJECT INFORMATION -
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING o MECHANICAL
0 DEMOLITION INELECTRICAL ❑ ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed des tion of work included on this fermit only)
SPCtiiC-e CU")VeeC l Orl CCrecke cd , C n06.-- Ito[_
PROJECT NAME(Name of Business or Owner Last Name) S` (.,151.1 6 \7) I I
PEOPLE INFORMATION
PROPERTY NAME.
A -O 1 PRIMARY PHONE
OWNER /v` �J�X.t(1 SQ l`OC.cr`r1 `-`T eP `1 C- j (LS3 ) -L-M-2.
MAILING ADDRESS CITY,STATE,ZIP
Sao \rt Cx S' -. 11-is \c..D,,(A A G(P.OG3
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE
C. \C� '---Dr)c- atc - . i-cc....)s (Z ) K3 -04
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
l��3 f a-" . t C JA quo arn66 -Gi3C
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2o-0 k - 1 o t `2› S-7 _
12 / 31 / j (2S3 ) F63 -C3-9
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
TC�
9 C� L s 3 4 4 G U S--- /3( / 05-
APPLICANT C, PANY NAME APPLICANT NAME
1\ op OFFICE PHONE
Gie\Cof.�In . 0kt(yet- F� -c c'ec...tr (2? )(96' -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
IlkCpl \' S. 3 c- Sc r2rC.A.11 qrS�C> K42,ri7(( -G\A 6
RELATIONSHIP TO PROJECT \ \ FAX NUMBER
0 Architect 0 Tenant 0 Agent ' .,Other(Describe)S \t C - (2S-31 `ty
3 -k
CONTACTNPRIMARY PHON
l`, � �J , c )2e p E-MAIL ADDRESS
-C,X� �-I CrilYlcac^!Q eb\elco,ne f•
LENDER Per RCW 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? o YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES o NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC) ,
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 PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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(comme,O,AI) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/sho..srCombo) SHOWERS WATER CLOSETS
_ tro,kN) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) 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.a 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.
joqNAME/TITLE DATE 44 �•
( tgnature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner o Agent ❑ Contractor ❑ Architect sir Other C -t-Grtyr-
FOR OFFICE USE ONLY
a NEW o ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? o YES ❑ NO DEMO PERMIT REQUIRED? ❑YES ❑ NO
Bulletin#100—March 30,2004 Page 2 of 4 k\I landouts—Revised\Permit Application