03-104797 f y
City on eWay
Communityty Development Services Electrical Permit #:03 - 104797 - 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: NORTHWEST CHURCH
Project Address: . 34800 21ST�A'G Parcel Number: 542350 0630
Project Description: Low-voltage electrical system to serve fire alarm upgrade.
Owner Applicant Contractor
NORTHWEST CHURCH MERIDIAN SECURITY&ELECTRIC(ELECT MERIDIAN SECURITY&ELECTRIC(ELECT
PO BOX 25110 P.O.BOX 7171 P.O.BOX 7171
FEDERAL WAY WA 98093-2110 KENT WA 98042 KENT WA 98042
(253)638-1792
Electrical Fixtures
4,7;
Low Voltage Fire Alarm-Commercia 4152
PERMIT EXPIRES April 19,2004.
Permit issued on October 22,2003
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: X�/""�v ' L Date: 1
Wa.l l ccs velem r0tA4D
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RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF �� APPLICATION NUMBER: 03- L C2 H79-200
Federal Way OCT 2 1 2003 APPLICATION NUMBER: -
kPPLICATION NUMBER: -CITY OF FEDERAL WAY
**The foll ga ergDE information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
:. :. 111 INFORMATION
SITE ADDRESS: 3 l gD 0 —2- S+ ,I/P ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL 0 ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): KO�/'0
Go -0. - . Tr'� -- r f --n
PROJECT NAME: 0CNtT1^-o .r s
_ :`.I-PEOPLE INFORMATION
PROPERTY OWNER: NAME: ; DAYTIME PHONE:
/)o -hu4es- - C-kw "c--
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
34 800 -2 Is#- A- Ie--Sw
CONTRACTOR: NAME: DAYTIME PHONE:
YVI e i �_`_ S-e- f � < < (z S}6 3 f 7f a
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): EVENING PHONE-
3.6 I c18o'7/2- ( )' �----rL i
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(-1S-3) fo3SI- 6376
CONTRACTOR'S REGISTRATION NUMBER:
p I EXPIRATION DATE:
(copy of card required) /'� T ld S Q 015-, 04-/
APPLICANT: NAME: I DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
� ( )
I
RELATIONSHIP TO PROJECT: j FAX NUMBER:
O ARCHITECT O TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER O APPLICANT o CONTRACTOR
.■ DETAILED BUILDING INFORMATION - ,/q
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ 7, Y y
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? *YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES (1'1 NO
WATER SERVICE PROVIDER: O LAKEHAVEN ❑ HIGHLINE O TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN O HIGHLINE O PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRO)ECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: Li'el Sze e3-11
■ 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) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ 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 daim),which may be made by any person,induding 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 city as a�parrt of this application.
NAME/TITLE: `" DATE: � . 2 3
❑ PROPERTY OWNER ❑APPLICANT CONTRACTOR
-FOR.OFFICE USE ONLY ,iI
CtM-F• ::. ,��;:, v.x_...'_ � �.� k": �v+_.:,,.. 1. �:j: 3 R^h,:.�.+i.-„�' ": � ...:ii=. _5.: K .s.w:: '_ay._ :
;NEW;; ADDITION ,;U ALTERATION� REPArn 0 TENANT:IMPROVEMENT
CENSUS:CODE•.. -. ac..';'1 :� ;r Mid
ZONING.DESIGNATION "• : �
-:. _, .,, .r , ,.: ��� ����� 12;�.:�BUILDIfVG�SHELL:ONLY?.�:❑YES;� _n NO ., :, �. .,:.'
COMP PLAN DESIGNATION , x BASIC PLAN? D YES fl NO
SECTION TOWNSHIP_ ' RANGE` _ NEWADDRESS'REQUIRED?, .:"a'YES =0NO =,y
P.LATTEU LOT? ❑YES''''LlFo7NO ,�,, CHANGEOF USE?44_, i3O YES ,f`:77.0'NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cityoffederalway.com