04-101272 CeveWay
Community Development Services Electrical Permit #:04 - 101272 - 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: ALLEN
Project Address: 36210 24TH I' vi 5 Parcel Number: 513100 0540
Project Description: Install one 20-amp branch circuit
Owner Applicant Contractor
Michael W Dickey ELECTRO SERVE LLC ELECTRO SERVE LLC
36210 24TH PL S 13547 SE 27TH PL SUITE 3-D 13547 SE 27TH PL SUITE 3-D
FEDERAL WAY WA BELLEVUE WA 98005 BELLEVUE WA 98005
98003-7159 (425)451-3358
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits-Residential 1
PERMIT EXPIRES October 3,2004.
Permit issued on April 6,2004
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. See Application 1 .
Owner or agent: _ Date: 0 1 r 01.
RECEIVED BY ARTMENT L
COMMUNITY DEVELOPMENT DEP
CONSTRUC 1 ION PERMIT"APPLICATIOI`
\>\> FEY 1.__
A r r0 6 2004 APPLICATION NUMBER:
APPLICATION NUMBER: - -
• ' APPLICATION NUMBER: -•_ _• -
**The following is required information-Please print(in ink)or type**
Please note: Electrical,Are Prevention S stems and Engineering permits may require a separate application,
..-. : . ; .. • PROPERTY INFORMATION
SITE ADDRESS:.p3`CD a�. \ J• "0, I, • , 99ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
t ;. ... �� - -. ,►�I PROJECT I -
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):SU cl c �J\ -\ QA X.4.�k+-
PROJECT NAME:
W! PEOPLE INFORMATION
T_
PROPERTY OWNER: NAME: •
+ DAYTIME PHO E:
\1 L)'Lo' �� (a3) $
MAIUNG ADDRESS(STREET ADDRESS;CITY,STA
au .
CONTRACTOR: NAME:
DAYTIME PHONE:
Electro Serve LLC . ( 425)653 - 4085
MAIUNG ADDRESS(STREET ADDRESS;CITY,STATE,71P): EVENING PHONE:
13300 SE 30th St Suite 105 RP11evue,WA 98005 (425)652x''4085.• :
CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER(: ";
- •
\ (eD k C7 c k - (425)562-4-948
CONTRACTOR'S REGISTRATION NUMBER:
ELECTSL042M2 EXPIRATION DATE:
(copy of and required) 7 /2 2 /2 004
APPLICANT: NAME `Sy DAYTIME PHONE:
MAILING ADDRESS(STREET ADD ;CITY,STATE ZIP) (4 s)1053 4LSZS EVENING PHONE:
� OQ
^ ��
73
RELATIONSHIP TO PROJECT: ' l'" ��) "c
(� ,� r
FAX NUMBER: (�
0 ARCHITECT 0 TENANT ❑ OTHER(DESCRIBE)\�-�}( 4E\cJ-AP_ 0- SI9�` ok p
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANTfCONTRACTOR
■ DETAILED BUILDING INFORMATION "' - -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ - I
.•- ■ PRO]ECT FLOOR AREAS -. - • —
•
•
FLOOR EXISTING SQ..FT. • PROPOSED SQ.FT. TOTAL •
• BASEMENT • •
•• •
•
FIRST •
•
SECOND • ' •
•
•
THIRD .
FOURTH
•
OTHER FLOORS(DESCRIBE) •
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
w.•'c+:.hd•F.+.«..::.%.>xo,..: "r4ir+iw•:arv+.piWirrill* X URESJt"r+.C+�+.asir. ••rig.+.r.}+.:rwoariw++r :.i..rro�i%k�ia�r-r ;a.::;�:.+aar�x.:i�rim7i
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: ❑ ELECTRIC ❑ GAS
PLUMBING •
BATHTUB(S) LAVATORY(S) URINAL(S) • WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S) -
•••M:DISCLAIMER/SIGNATURE BLOCK. : = _
I certify under penalty of perjury that • e 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 daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,b t only where such da*, • "ses out of the reliance of the city,induding its officers and employees,upon the accuracy
of the inform. :o upplied to‘the ci . part of this application.
--6\IX
NAME/TITLE: A A., .41.1. / DATE:
❑ PROPERTY OWNER 0 APPLICANT 'CONTRACTOR'
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COMMUNITY DEVELOPMENT SERVICES.•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dty ffederalway.com