04-104999 City of Federal Way Electrical Permit #: 04 - 104999 - 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) 835-30513
Project Name: 7-11
Project Address: 28719 MILITARY g. tea S Parcel Number: 332204 9161
Project Description: Rewire and install updated tank monitoring system with intrinsically safe wiring.
Owner Applicant I Contractor
THE SOUTHLAND CORPORATION S M E CORPORATION*DON RUTH* S M E CORPORATION*DON RUTH*
PO Box 711 2302 A ST 2302 A ST
TACOMA WA 98402 TACOMA WA 98402
PO Box 711 !Dallas,TX 75221-0711 (253)572-3822
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Low Voltage-Other Commercial 1
PERMIT EXPIRES June 8,2005.
Permit issued on December 10,2004
I hereby certify that the a 've informatio, s correct and that the construction on the above described property And
the occupancy and the u' will be in ac i ante with' i,. laws,rules and regulations of the State of Washington and
the City of Federal Way / ..
Owner or agent: BsiiNINI Date: /7/.. LQ -
eCb3-6"
FINALED
THIS CARD IS TO REMAIN ON-SITE ' `
:AICITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104999-00-EL
Owner:
Address: 28719 MILITARY RD S
FEDERAL WAY, WA 98003-3332
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.
0 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
. . -- • -
0 Rough Electrical(4225) �❑ Ceiling Cover(4020) Final-Electrical(4055)
Approved Approved Approved
By Date By Date B ��. Date/2r/7
❑ Under-slab groundwork(4295)
Approved
By Date
. 'CITY Of 41111111116......." 0 i — I—.° I C?
Federal Way RECEIVED
kF COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF CO M EL PL DE EN FP
JJJFEDERAL AVENUE Y253-835-2609
C 0 al/APPLICATION (° ______4_________
253-3 6fAX
uuu atyofederahaa4com /
following is r LG sERALWAY
The
j 9 3' ?'f' rt,{•r• a• ;i -an incomplete ap.lication will not be acce.ted. Please .rint legibly(in ink)or type.
•a d PROPERTY INFORMATION
QI
SITE ADDRESS �L I c Put/( ,(,.4-- (� SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# ___„„„1__.2...-___00.1- LOT SIZE(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desoipioc)
r= I. PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING `❑ PLUMBING 0 MECHANICAL,
0 DEMOLITION CECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlui
tAr _ _ c _ - r
PROJECT NAME(Name of Business or Owner Last Name) 1 "'"Z/i
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER rt —LA
( )
MAILING ADDRESS CITY,STATE,ZIP
6,2''Y7 t 1 Atvi ti-4,L194 . gecs . viet_i _ _
CONTRACTOR COMPANY NAME AP CANT NAME OFFICE PHONE
MAILING ADDRESS O ` CITY,STATE,ZIP� ` CELLT��NE
,1, o-- VIC s- Ac . Lily -1kuoZ( 1
CILICENSEUMFAX NUM
OF FEDERAL WAY BUSINESS NB R EXPIRATION DATE FBER
CZ0-DO--� 0f 1- B L i�-/ Y( 10y ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each applications EXPIRATION DATE
I /
APPLICANT COMPANY NAME
APPLICANT NAME OFFICE PHONE
i-y G
MAILIADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT • FAX NUMBER
o Architect ❑ Tenant o Agent ❑ Other(Describe) ( ) -
CONTACT NAME b6PRIMARY PHONE
E-MAIL ADDRESS
,.1 u ., ('/ ) S7 Z- 1r Z Z
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
- .■ DETAILED BUILDING INFORMATION
EXISTING USE , r e PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
' WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ IIIGHLINE ❑ 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 C]STDtG TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
“NEW HOMES ONLY"° NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FITURES • -
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing factures to remain. ii
• MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm<rdat( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES - MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tob/Showor Combo) SHOWERS WATER CLOSETS(rod<q 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
_:DISCLATINER/SIGNATQREBLOCR - _
I certify under pen• ty of perjury that t e information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the •wner of the above •remises to perform the work for which the permit application is made. I further agree to hold
harmless the City of ederal Way as t• a claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim), which •y be made bya i• rson,including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the rel ance of the city uding it officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. /
NAME/TITLE 111DATE k"—(1/--07 '
(Signature) (Title)
RELATIONSHI• TO P••JECT o O‘ 1,r 0 Agent 0 Contractor 0 Architect 0 Other
( FOR OFFICE USE ONLY
a NEW ❑ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? a YES ❑NO DEMO PERMIT REQUIRED? a YES o NO
f
Bulletin,#100—March 30,2004 — Page 2 of 4 k\l-Iandouts—Rcviscd\Pcrmit Application