02-104303 City of Federal Way
Community Development Services Electrical Permit #:02 - 104303 - 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: ROBERTSON
Project Address: 31019 48TH SW Parcel Number: 184080 0110
Project Description: ELE-Electrical for new addition. Receptacles and lighting.
Owner Applicant Contractor
MICHAEL ROBERTSON MICHAEL ROBERTSON MICHAEL ROBERTSON
31019 48TH AVE SW 31019 48TH AVE SW 31019 48TH AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(206)341-5011
Electrical Fixtures
14. aTEMI1111 r� TIV.4EVJaescilOtiiiiAttl IMII4:21esOcii)tion:[ r; F: 0Quandt r
Circuits-Residential _j 4
PERMIT EXPIRES March 31,2003,IF NO WORK IS STARTED.
Permit issued on October 2,2002
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: G7 /lr P-L ?1c_.._._._ Date: Cel 6Z1pZ
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arYOr _ CONSTRUCT I ION PERMIT APPLICATION_
\>\> i� _ `RECE1 VEp APPLICATION NUMBER: 0-- L C,4,•;o -
��.r 0 APPLICATION NUMBER: - -
2 2002APPLICATION NUMBER: - -
**The fo Ah Gfj nn��rhe q rmation-Please print(in ink)Or type**
Please note: Electrical,Fire PreveDUntion SyLt mss and Engineering permits may require a separate application.
1
- :4 PROPERTY INFORMATION
SITE ADDRESS: 31O V 4c AO e Sk--ej ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
-,- -::•"!•::-•••-"--...:::!,'-•:-•.- :.--'":•-•'-':':':--:"..F:!;--:: - 1i PROTECT INFORMATION. . , -•, . . :
TYPE OF PROJECT(This application): UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
4 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
1
PROJECT DESCRIPTION (Provide detailed description): 4A t_oc 3 F(,ep--1.6,h iPS r;yt e ( j , h,,
To A UOcD 1- . (jJ -4 :c„-. .
II PROJECT NAME:
:i PEOPLE INFORMATION •
T.
� ROPERTY OWNER: NAME: DAYTIME PHONE:
41 lies � -sw. (-S3 )83 f -6'624(7 j MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER. FAX NUMBER:
( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: DAYTIME PHONE:
)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
1 RELATIONSHIP 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 VAL • • ; • OR IMPROVEMENTS: $
SPRINKLERED BUILDING? El YES ❑ • • ••RESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ■ EHAVEN ❑ HIGHLINE ❑ TACOMA ■ ••• ELL)
SEWER SERVICE PROVID •. ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
. ■ PROSECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL •
•
BASEMENT
FIRST
•
SECOND
'
•
THIRD •
FOURTH
OTHER FLOORS(DESCRIB
DECK
GARAGE
HOW MANY FLOORS? •
TOTAL:
.-w.-.•...n c,e+..u,. .- .,.>.�.-...w..�.......,s +�p1»W 66raiwi III'IF TURESJi+'Ksayss• e::.w..w+.--H,:.rw>a:i.,»,..E;.ir'esv+:+%riser.srr-+aiv,:r�-.iaHtiay.w r, i.b.
dicate numb- of each type of fixture
MEC :NICAL
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
BAT B(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
D = WASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
.RINKING 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 th:t . 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 claim(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,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information suPp. d the • a. a p. of this application.
NAME/TITLE:.,_
/ ^`r-- DATE: 62614/;)----
M./PROPERTY OWNER ❑ APPLICA ❑ CONTRACTOR
_FOR-OFFICE USE ONLY:1
=NEIN E - ❑,ADDITION i-❑ALTERATION; ?'_ REPAIR: z? `_❑TENANT-IMPROVEMENT4-
CENSUS.CODE:
, -
-"
OIfING '�
_ �ESIGNA-TY(jN _;;�_:��',-_,;-- --• 1=� ;BUILDING SHELL ONLY?` ES N
�❑1f ": ❑ U. "=_= _�;=�'•
COM $ AN DESIGNATION
-_ _ :. , _ -- =�BASZGPLAN> ;'�❑�fEB`,�°'-IVO >�-,:� . _.
SECTION "`Kr:' '-TOWNSHIP='=r"_RANGE :,1; - :NEW-ADDRESS REQUIRED?; ;_`- ❑ YES`'-; D NO :y
PLATTED-LOT? ❑ YES ,❑"-NO - - '_- CHANGE OFUSE?" - -`❑YES :` ❑"NO ' :''
COMMUNITY DEVELOPMENT SERVICES_•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffederalway.com