03-104376 City of Federal Way
Community Development Services Electrical Permit #:03 - 104376 - 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: NELSON
Project Address: 29433 19TH Ave 6 Parcel Number: 672050 0090
Project Description: Upgrade utility service panel.
Owner Applicant Contractor
Sherry Gayle Nelson Sherry Gayle Nelson Sherry Gayle Nelson
29433 19TH AVE S 29433 19TH AVE S 29433 19TH AVE S
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
98003-3813 98003-3813
Electrical Fixtures
Description, Quantity Description IQuantity Description Quantity
Alt.Serv/Feeder:0 to 200 amps-Res. 1
PERMIT EXPIRES March 21,2004.
Permit issued on September 23,2003
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 accordan - with the laws,rules and regulations of the State of Washington and
the City of Federal W . / r�
Owner or agent. _ :1 `L �� Date: 6)CI
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CONSTRUC I ION4P
L PERMIT APPLICATIO
CITY OF �.i APPLICATION NUMBER: QA- J 0 d32 (2- Co
Federal Way APPLICATION NUMBER: -
kPPLICATION NUMBER: -
"The following is required 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: (9 03 19 0 -' v • ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING 0 PLUMBING ❑ MECHANICAL o DEMOLITION
>ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provid• detailed descr•.ti• ):
.......0 L, _i A/i. . _ � -4.0,. iL:
/ .
i PROJECT NAME:
- / PEOPLE INFORMATION. -
PROPERTY OWNER: NAME: / / O
i:5?3a
7 -. 30e
MAI A ••Ei •r.RES , .P):
le / , (S
CONTRACTOR: NAME: / i DAYTIME PHONE:
/ I ( )
MAI 'G ADDRESS••EET••`.DRESS;CITY,STATE.ZIP): I. EVENING PHONE:
I{ :( )
I CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: I FAX NUMBER:
- I ( ) - I
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(copy of card required) 1 / /
I
APPLICANT• NAM'1111WrilffigrArligro Dc•• TO - /
G:•DRE�E/ •.' ,//H EV INGP/`: / # 0 r
• • ONS P Ti PRO - i �i FAX NUMBER: lJ'�/
o ARCHITECT NANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS: I
I
CONTACT PERSON FOR THIS PROJECT: • •ROPERTY OWNER 0 APPLICANT ❑ CONTRACTOR
- ■ DETAILED BUILDING INFORMATION -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
>60 SPRINKLERED BUILDING? ❑YES FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
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) RANGES) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINALS) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING 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 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense •f such daim),wh' may be made by any person,induding the undersigned,and filed against the City of
`Federal Way,but o i wh - such daim ari s ut of the reliance of the city,induding its officers and employees,upon the accuracy
of the information(. •p1' • to the city as a rt of th appli tion.
NAME/TITLE:, / d DATE:LY,.../2625IZ1 25
❑ PROPERTY OWNER o APP NT ❑CONTRACTOR
FOR OFFICE.USE ONLY:
DDITION ,,: C7 ALTERATION..W ❑.REPAIRazizCl TENANT-IM PROVEMENT "
CENSUS CODE € •t �s � a : � t x5. Fs s
ZONING'�DESIGNATION' ' . . BUILDING SHELL'ONLY?., O YES; =17 NO ,
COMP PLAN DESIGNATION ' ;
SECTION . ,;e,.TOWNSHIP ' RANGE y .NEW ADDRESS REQUIRED? =oYES t3'NO
PLATTED LOT? t n YES .,o NO '` ' ' CHANGEOF USE? n YES
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.citvoffederalway.com