05-100953 City of
umlyFederal Way Electrical Permit #: 05 - 100953 - 00 - EL
Commonly 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: CONOCO-PHILLIPS GAS STATION
Project Address: 2100 SW 356TH ST Parcel Number: 252103 9036
Project Description: Remove and replace light fixture ballast.
Owner Applicant Contractor
TOSCO CORPORATION*TOSCO CORPORA CHRISTENSON TECHNOLOGY SERVICES CHRISTENSON TECHNOLOGY SERVICES
72 CUMMINGS POINT RD 631 NW THERMAN ST FLOOR 2 631 NW THERMAN ST FLOOR 2
STAMFORD CT PORTLAND OR 97209-2558 PORTLAND OR 97209-2558
06902-7919 (503)419-3600
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits- Commercial 1
_ PERMIT EXPIRES August 28,2005.
Permit issued on March 1,2005
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 Whshington and
the City of Federal Way.
See Applicati Date:
Owner or agent: Qn 03—O r — (/,#/
(as
J
Fu4ALEr.. oC
THIS CARD IS TO REMAIN ON-SITE •
CITY OF A Community Development Inspection Record
Federal Way IVR INSP$CTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-100953-00-EL
Owner: TOSCO CORPORATION
Address: 2100 SW 356TH ST
FEDERAL WAY, WA 98031
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.
.❑ 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) ,❑ 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 B 73 Date T---`7'.
❑ Under-slab groundwork(4295)
Approved
By Date
N AUTOMATION FEE:$5.00
RECEIVED BY 1-5CIRCUIT ALTERATION = $89.00
f AcommUNITY
DEVELOPMENT DEPARTtM�clv'" TOTAL FEE: $94.00 "•�
crnoF ELECTRICAL 0 - ( (2_Q, T
Federal Way FEB 2 2 2- n5 PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO M�PL DE EN FP
33325 AVENUE SOUTH•Po BOX 9718 APPLICATION TD
FEDERAL W.4Y,WA 98063.9718 / /
253-835-2607•FAX 253-835-2609
www.cityoff deralwaq.cum JOB• 67-44958
The ollowin, is re• ired in ormation-an Inco •lete . ••lication will not be acce• d. Please •rint le•ibl in in or • .
• PROPERTY INFORMATION
SITE ADDRESS 2100 SW 356TH FEDERAL WAY 98023 SUITE/UNIT# N/A
*UNKNOWN TO CONTRACTOR
ASSESSOR'S TAX/PARCEL# _ _ - LOT SIZE(4)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) *
(Attach separate page for lengthy legal descr.ption)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION X(ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
REMOVE 400W BALLAST AND REPLACE WITH 200W BALLAST IN LIGHT FIXTURE. REPLACE LENSE IF NECESSARY
LSI INDUSTRIES CONOCO-PHILLIPS STATION # 2603160
PROJECT NAME(Name of Business or Owner Last Name)
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER CONOCO-PHILLIPS ( ) -
MAILING ADDRESS CITY,STATE,ZIP
AS ABOVE
CONTRACTOR 1 COMPANY NAME APPLICANT NAME OFFICE PHONE
HRISTENSON TECHNOLOGY SERVICES,INC. (503 )419 3600
MAILING ADDRESS CITY,STATE,ZIP CELL PHONEIOM KOSMAS
1631 NW THURMAN ST 2ND FL ?ORTLAND, OR 97209-2558 603 )260 -4269
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
PENDING
-B L ) / (503 )419 -3636
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
C H R I S T S_ 9 Z 7 Q G 11 ) 3 )05
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
SAME AS CONTRACTOR ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1631 NW THURMAN ST 2ND FL PORTLAND, OR 97209-2558 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
TOM KOSMAS ( 503 ) 260-4-269
LENDER r NAME
N/A ItL,,;°,,,,q°'!,
, !, ,>..N eacceeds `','s,
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE STATION PROPOSED USE SAME
*UNKNOWN TO CONTRACTOR
EXISTING ASSESSED/APPRAISED VALUE $ N/A VALUE OF PROPOSED WORK $ 1,658.00
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
*
WATER SERVICE PROVIDER *❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
e N/A
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
— SQ.FT. _ SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
EXISTING PROPOSED OF FLOORS TOTAL r��a ' '`i °z' '+
j:nht
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
N/A FIXTURES
Indicate number of each type of fixture 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(commem;aq WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS)or Tub/showercombo) SHOWERS WATER CLOSETS)Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS)Bathroom sinks) 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. Ifurther 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 L—�-J�� •-✓K -�R�a�� b ".MARK WALTER PRESIDENTDATE 2/16/05
t�tature) (Title)
RELATIONSHIP TO P JECT 0 Owner 0 Agent glr)tontractor 0 Architect 0 Other
a NEW v ADDITION o ALTERATION ❑F PAIR.. ci TENANT I N Ia `' '4;;,,, „ , .
BUILDING SHELL ONLY? �'ES a NO BASIC PLAN?., _ ° '' D:� a NO
�INGDEIGNATION + (V .wV rhe w� l " . CHANGE OF USE? ' `. o El NQ
NEWWADD **Q RED? ��.t® 1 ." , a . 'UP/SEPA/SUP . . ..,:,,,,;,„-,..:„:-.,--..o YES-. a NO
t�' „ !;. �,� ���� fel`*
x, LOTP -:,< t ,: +„'' ; ' ittEMO-PERMIT P Eo YES a NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application •