04-101179 A
City or Federal Way
Commtmity Development Services Electrical Permit #:04 - 101179 - 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: KO-AM TV
Project Address: 720 S 320TH 55+ Parcel Number: 082104 9266
Project Description: Low-voltage for antennae hookup
Owner Applicant Contractor
CAPITOL SQUARE L L C KO-AM TV*SHELLEY KO* SIGN-TECH ELECTRIC
PO Box 18194 728 S 320TH ST PH G SIGN-TECH ELECTRIC
FEDERAL WAY WA 98003 33759 9TH AVE S
PO Box 18194 !Seattle,WA 98118-0194
Electrical Fixtures
000 34AfigfilreWil5triser �,'at' '•=jQ. tyii*DBSCCIpt" .W-,��(ntity
Low Voltage-Other Commercial 1
PERMIT EXPIRES September 28,2004.
Permit issued on April 1,2004
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: - 14-1
5�teio�l 1 i► lanais ,Q
0
SERVICES
Cm ofit
R,EGE,IV ED COMMUNITY DEVELOPMENT
33530 FIRST WAY SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718
Federal Way 3 2oopERMIT APPLICATION ElI- 253-661-4115.FAX:253661-4I29
unow atynQedernlway mm
MAR
For Office Use Only '' — — TD
:(i)L�(NG DEPT.
The ollowin. is re. re n ormation-art incom•lete a.•lication will not be acce.ted. Please •rint le.ibl (in ink)or •e.
■ PROPERTY INFORMATION
SITE ADDRESS: 7-1-o S . )13 4'1A .S7( . T /ti i'JA '-i 3'Lt' SUITE/APT#
ASSESSOR'S TAX/PARCEL#: - SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
- ■ PROJECT INFORMATION •
TYPE OF PERMIT(This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION
❑ ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only):
I 3 ANA-Ise-1A n c-N_.
PROJECT NAME(Name of Business/Owner Last Name): Kc-A%v1 -TV
V
■ PEOPLE INFORMATION
PROPERTY NAME: PRIMARY PHONE: /
OWNER W'-`---1Y))R> r'L-24'lt4 ( L,) -i>'S' -�S1Gv
MAILING ADDRESS(STREET ADDRESS;). CITY,STATE,ZIP
P '3 0'y / /' ," sp,4k , t--:A li j,
CONTRACTOR NAME „.- COMPANY OFFICE PHONE:
,,h JWL :-..->I'e34`17--re cit (--63 ) ?►1U - a7)(14
MAILING ADDRESS(STREET ADDRESS;). CITY,STATE,ZIP CELL PHONE:
'33'7s' �;H' f ice. S_ '7.i...`. t- C:)S-'6�.3 ( as-3 ) 11/3 - 3(Z D4
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
/ / ( ) -
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required with each application) /
LENDER NAME: DAYTIME PHONE:
(II Proposed Value>$5,000) ( ) _
MAILING ADDRESS(STREET ADDRESS;). CITY,STATE,ZIP
APPLICANT: NAME: COMPANY OFFICE PHONE-
-1 11.e tFe . / -; .- A t\ ZL/ ( s-3 ) ':�� - ...,--n 9
MAILING ADDRESS( REET ADDRESS) CITY,STATE,ZIP EVENING PHONE
`ik >1wii., •' TIc, ( /- t 4t'- C-).:`t s (''.t-3 ) -33,1.- - /f3
RELATIONSHIP TO PROJECT: FAX NUMBER: /
0 Architect 0 Tenant 0 Other(Describe): ( - S 3 r)4.Z ->C. t)
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner 0 Contractor ❑ Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES ❑.NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 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: $
M FIXTURES
Indicate number of each type of fixture that is 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(commerdaT)
WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS Irma t) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(T3athroom sun 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 and a loyees,upon the accuracy of the information supplied to the city as a part of this application.
NAME/TITLE: ti• `+ DATE: '/ 3) I
CfL-
(Signature) / (Title)
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant ❑ Contractor ❑ Architect ❑
FOR OFFICE,USE ONLY:
o NEW a ADDITION a ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES a NO
ZONING DESIGNATION: CHANGE OF USE? a YES a 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
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