05-100052 R s
City of Federal way Electrical Permit #: 05 - 100052 - 00 - EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: DIETRICH
Project Address: 35803 11TH 135iV J4 Ve., 5 V✓ Parcel Number: 440560 0035
Project Description: Replacing meter base
Owner Applicant Contractor
James T Keller ON TIME ELECTRIC*SOLOMON ADAMS* ON TIME ELECTRIC*SOLOMON ADAMS*
35802 11TH AVE SW PO BOX 8074 PO BOX 8074
FEDERAL WAY WA LACEY WA 98509 LACEY WA 98509
98023-7234 (360)459-9341
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Mast or Meter Repair-Residential/M+ 1
PERMIT EXPIRES July 5,2005.
Permit issued on January 6,2005
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 Washmgton and
the City of Federal Way.
Owner or agent: . /' . � , ,�� Date: //4, /o S
FINALED
THIS CARD IS TO REMAIN ON-SITE
CIof ACommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-100052-00-EL
Owner: JAMES T KELLER
Address: 35803 11TH AVE SW
FEDERAL WAY, WA 98023-7234
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Slab/Concrete Floor(4255) 0 Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date �By,/ Date
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) / " Final-Electrical(4055)
Approved Approved Approved
By Date By Date BDate 712
❑ Under-slab groundwork(4295)
Approved
By Date
5`Federal Way PERMIT
T COMMUNITY DEVELOPMENT SERVICESySF MF CO ME EL PL DE EN FP
3332FEDERAL WAY,WA98063-BOBX:3 N 2°°APPLICATION TD
253-835-2607•FAX 253-835-2609 h� sr
/ /
www.aluofederalwau.comi ,--",_:DER aaY AL
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The following is requug-- t1�rCrnarion4-an incomplete ap.lication will not be acce.ted. Pleaseibl rint legibly g' y(in ink)or type.
;. - • PROPERTY INFORMATION
C / ,•I Q 8'',0
t
SITE ADDRESS 3� Q d.3 ft/l (hi, cS u.5 Fe,dr.4 Ivo,- / W i (0 O 2,� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# "/ Li 0 LJ C(7 0 - n C _ 5 LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page jar lengthy legal descnp ion)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL
0 DEMOLITION Q E ECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
PROJECT NAME(Name of Business or Owner Last Name)
11 PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 7110in4S -DT�r j ah (z ) Y7Z - 5765'5
MAILING ADDRESS CITY,STATE,ZIP
z q t 2._ t s—IGt /4-Vt. E Ser.-f---I-(r_, WA- ?Fit.2-
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
0N T'i me. E ie1✓t-r t`c. So t o mon. A c1 c,wvs ( ) YS y - ?g4'/
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE -
P
CITY OO8F FEDERAL WAY BUSINESS LICENSE NUMBER l t 18"5-0/EXPIRATION DATEFAX NUMBER
3 -6203 26 3 -
/ / ( 360 ) 575` - 8b Z6
B L
CONTRACTOR'S REGISTRATION NUMBER 1.,....t.......4......s...a...4th each applications EXPIRATION DATE
T TMEE T 36217Z // loz /,2006
APPLICANT COMPA NAME APPLICANT NAME OFFICE PHONE
TnUIP pPy/C ( )
-
MAILING ADDRCITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT • FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
LENDER
-4,Per �W °l7 095z nder4jorinatson is' :,1 NAME
uu7,�r�ed f pro jest value eezceeds$5 000:F,
MAILING ADDRESS CITY,STATE,ZIP
.■ DETAILED BUILDING INFORMATION -
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
' . WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGILLINE 0 PRIVATE(SEPTIC) .
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ—.FT. PROPOSED sq.FT. TOTAL p
BASEMENT � I
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS?
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offacture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
• MECEIANICAL
Value of Mechanical Work $
•
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS
HOODS(comm<mlaIj W OO D STO V ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING (Describe)or Tab/ShowerCombo) SHOWERS WATER CLOSETS 00,ko MISC( )
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
- , _ - DISCLAIMER/SIGNATUREBLOCK. _
•
•
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 employees,upon the accuracy of the information supplied to the city as a part of
this application.NAME/TITLE -.----1464/144Y7 C661- `_
R TDATE //6/0 S'
(Signature) t
1 RELATIONSHIP TO PROJECT ❑ Owner ❑Agent ❑ Contractor ❑ Architect 0 Other
FAFF
ORICE USE ONLY?II
o NEW a ADDITION o ALTERATION o REPAIR .6 TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO- BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? a YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
•
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Bulletin#100-March 30,2004 - Page 2 of 4 k\Handouts-Revised\Petmit Application