03-104704 City of Federal Way
Community Development Services Electrical Permit #:03 - 104704 - 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: JENSEN
Project Address: 28922 5TH 6 Ave S Parcel Number: 515298 0010
Project Description: Install 200-amp service for new,single-family home.
Owner Applicant Contractor
TERRY JENSEN CONSTRUCTION CORP ADVANCED ELEC&SECURITY INC ADVANCED ELEC&SECURITY INC
TERRY JENSEN CONSTRUCTION CORP 10218 32ND ST E 10218 32ND ST E
PO BOX 1326 EDGEWOOD WA 98372 EDGEWOOD WA 98372
ISSAQUAH WA 98027-0058 (253)848-8706
Electrical Fixtures
Description Quantity Description OQuantity Description !Quantity
Service: -Residential 4866
PERMIT EXPIRES April 12,2004.
Permit issued on October 15,2003
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: ,di Date: C o /t S A 7
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Cr;Of G RECEIVED CONSTRUCTION PERMIT APPLICATION
� ���L APPLICATION NUMBER: ( �- 041011-( 0
OCT 1 5 2003 APPLICATION NUMBER: - -
CITY
R'IO�FpFEDERAL WAY
APPLICATION NUMBER: - -
**The follok'til T$'r' utt�d�information—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
• _PROPERTY INFORMATION
SITE ADDRESS: 2820 5vet/ e__• 3 . ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
. •. PROJECT INFORMATION , . -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION Provide detailed description):` kat) Si/tj r-CS/6 4,,tn, )'( i "t
e it G fri iW i 7-49-0 Aw•- , �l t'41 Sci uj r-e.
PROJECT NAME: 7,-F J-&y 'I S. ec.
;' ■ :PEOPLE INFORMATION
PROPERTY OWNER: NAME: Ter
S�/��/,/��� �//� (DAYTIME P`/HONNEE,:�'�'J MAILING ADDR RE ADD ESS;CITYSTATEZIP) CsCup.
(L125-" 6lJ 7 - /5
TC) I 32--(--C ---t.2 •A__Cta.a../k\ 1 ( -)A-- gO ___•--7
CONTRACTOR: NAME: a , DAYTIME PHONE:
Acker, d l / c SeCtfA , ` % .mac (z5-3) g ig - 8 700'
MAILING ADDRESS(STREET ADDRESS;CITY STATE,ZIP): EVENING PHONE:
10 2 t 8 E2')C Sf E ,k.)006 9 7 a_(" ) - ` '
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER 8 - L S 3°.t - Cr FAX NUMBER:
g Yg - / 9 1D
CONTRACTOR'S REGISTRATION NUMBER: �� EXPIRATION DATE:
7 �03 S
(copy of card required) Dq ca C / /
APPLICANT: NAME: ,-7 n • DAYTIME PHONE:
4 'a,1l G!e< ly;c I__ie oilc/ _The- . (25-3 )8 �/g -8 7ocpi
MAILING ADDRESS(STREET ADDRESS;CITY,STATE ZIP): / r EVENING PHONE:
/00)-i 32 401 SFE ede,000c1 1 v3A- y g37a ( i' ) _ ,1
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT C HER(DESCRIBE): /('17 (L.C6�'1 53)g`/70/�7 / ,/It)
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 VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO (
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)