03-104134 City of Federal Way
Community Development Services Electrical Permit #:03 - 104134 - 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: HAWORTH
Project Address: 1333 SW 323RD 5i" Parcel Number: 010450 0190
Project Description: Upgrading existing 200 amp panel to new 200 amp panel,including new circuits for new addition.
Owner Applicant Contractor
Michael R Haworth &Navine G Haworth KOLYN ELECTRIC*KOLYN ADAMS* KOLYN ELECTRIC*KOLYN ADAMS*
1333 SW 323RD ST 33232 37TH AVE SW 33232 37TH AVE SW
FEDERAL WAY WA FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
98023-5536 (206)351-3723
PERMIT EXPIRES March 3,2004.
Permit issued on September 5,2003
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: lj Date: e9 9 t 5 ^ d
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• ` RECEIVED
�� _ . CONSTRUCTION PERMIT APPLICATION
CITY OF �� SEF 5 2003 03- La //314 - .c G(.
APPLICATION NUMBER:
Federal Way APPLICATION NUMBER: - -
ow{ OF FEDERAL WAY APPLICATION NUMBER: - -
BUILDING DEPT•
**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
7
SITE ADDRESS:/-T-7-3 32,3 $'c2J S" ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.. I PRO3ECT INFORMATION _ " --
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
yFLECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): U,,/e -OG 9Ge) d,/,://.17 2 z ' r
1. , iG r -- .. S fD , T�'� 4-a.6' Z _.5" ,,e6---s
PROJECT NAME: , ?,,4-.14"_... ... ,r �1 A/Z /L
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: D� ., ; DAYTIME PHONE
� 4 .�• t & ; ( - 3 )7/5 -797fI
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
/333 323 .5w-- � ,-r_,D. A,' 7-
CONTRACTOR: NAME: r' DAYTIME PHONE:
esl�c i....� (2a4 )3S/ -37?3
MAILING ADDRESS(STREET ADDRESS;CITY.STATE,ZIP): EVENING PHONE:
_350.3z 37 T�i4-'e i' ( )S4
CITY OF AL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
f-e-a w,dr off - l0C3 / - 0 ( ) -`74
CONTRACTOR'S REGISTRATION NUMBER:
I EXPIRA ON DATE:
(copy of card required) I (2,--/ 3/ /
APPLICANT: ( NAME:
DAYTIME PHONE:
/.14, �,c/ 4 7.D",�-S b?53"A) 35/ - .37,31
MAILING ADDRESS 13
-3Z3(STREET A37
;CITY�T fA-c, s (ENING PHONE� e,
I RELATIONSHIP TO PROJECT: FAX NUMBER: ''
❑ ARCHITECT ❑TENANT o OTHER( DESCRIBE): ( ) //{///'lv^/'
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER 0 APPLICANT .@SCONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
'
SEWER SERVICE PROVIDER: 0 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
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) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) 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 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 daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the Information supplied
to the dty ass a part of this application. �yJ
NAME/TITLE: //l/1i7- UG�G.,�/Pj G DATE:
❑ PROPERTY OWNER ❑APPLICANT o CONTRACTOR
-FOR OFFICE.USE',ONLY:<;1
O'NEW,- ,.O ADDITION, ,.. a ALTERATION P* ;n.REPAIR .fin=TENANT-IF PROVEMENT ` „ ,
:CENSUS`CODE bs * � z�. r :LOT.SIZEr
ZONING DESIGNATION;. st3 ... . 4BUILDING SHELL ONLY? OYES U NO.,_
COMP PLAN DESIGNATION ? ,. ABASIC PLAN? .,❑YES :o NO'-°"
SECTION; •,sTOVIINSHIP a. , RANGE .NEW ADDRESS REQUIRED? '=:'❑YES a NO
PLATTED LOT? 5❑YES J,==LNO 'CHANGE OF USE?,-,7, ,,',1"---13 YES °Th NO
• COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffederalway.com