03-100349 ofF
I City Development Services eWay
Community Electrical Permit #:03 - 100349 - 00 - EL
1 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: SPENCER CHIROPRACTIC
Project Address: 32717 1ST S-IJe;tS Pt tie tAn't S Parcel Number: 182104 9047
Project Description: Install a 70-amp feeder for x-ray machine and relocate receptacles in existing office.
Owner Applicant Contractor
Floor Covering Pf*Floor Covering Pf Resilient' D J ELECTRIC AND CONSTRUCTION INC D J ELECTRIC AND CONSTRUCTION INC
12886 INTERURBAN AVE S 20532 303RD ST DE 20532 303RD ST DE
SEATTLE WA MAPLE VALLEY WA 98038 MAPLE VALLEY WA 98038
98168-3318 (425)432-2513
Electrical Fixtures
:f 4040th ," De cfipfic�
Alt.Serv./Feede:up to 200 amps-Co 1
PERMIT EXPIRES July 23,2003,IF NO WORK IS STARTED.
Permit issued on January 24,2003
I hereby certify that the abov- b on is correct i�that the construction on the above described property and
the occupancy and the use-Orbe' : •. ce�r° the laws,rules and regulations of the State of Washington and
the City of Federal Way
Owner or agent: / r Date: /
"2. (g /1)17t.gl -f, 414/ Speci_ f--e)1Z-
2 I 'o 3 C� � , � ./? k ,d - �
'Ai.-- ` RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF V"-V' APPLICATION NUMBER: CZ- 1 U03 -1 -(jQ ez_
Federal Way JAN 2 4 2003 APPLICATION NUMBER: -CITY OF FEDERAL WAY APPLICATION NUMBER: - -
**The following IisDrequlrreaFFI�nTTTbrmation-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION -
SITE ADDRESS: .S Z 70 ( ( -r%4L '., ASSESSOR'S TAX/PARCEL #: -
SIcC S—
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MECHANICAL ❑ DEMOLITION
*ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): /51.b !� -/2 9 c., IZC c ' , — k(7-00 c.401
Su'tfiS - / - ?C /9i F---Z7 -k•2t-`'1-- — 124 -C'C=¢-T: L/6c( ec-4
PROJECT NAME: S p6,71)cL)t chttxO P/ 'f-c._77i_
■ PEOPLE INFORMATION
PROPERTY OWNER: I NAME: i DAYTIME PHONE:
• MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
l �
CONTRACTOR: NA E: DAYTIME PHONE:
.A , LZC C?72-/C- A 0C-7?o / ZgG , (a 06 ) 3 56 - 2 P
MAILINGD S( EET ADDRESS;CITY,ST ZIP): EVENING PHONE:
CITY OF FEDERAL WAY LICENSE NUMBER: 7 -�� i FAX NUMBER: -
CONTRACTOR'S REG TION NUMBER: I EXPIRATION DATE:
(copy `1. J L S C4---C- 2- G 2..-z L 2: / /
or card required)
NAME: i DAYTIME PHONE:
APPLICANT:
.S
7)CN"C L Chi
l� -e o 4 2,E-c77 C ( ) -
MAILING ADDRESS_(STREET DRESS;CITY,STATE,ZIP): { EVENING
ENING PHONE:
RELATIONSHIP TO PROJECT: II FAX NUMBER:
o ARCHITECT W.LENANT o OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER ❑APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE o TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ 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 uch ),which be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only wh• • s -! • a 't of the reliance of the dty,induding its officers and employees,upon the accuracy
of the information sup• '• • • �.''. as : • of this'application.
NAME/TITLE: if DATE: / ? ---®.3
o PROPERTY OW R o APO •NT /ASSA)NTRACTOR
FOR.OFFICE.USE,ONLY
.i1 i NEW E ,a ADDITION x =D ALTERATION, 'ooREPAIR a TENANT>IMPROVEMENT -f„,.
CENSUS_:CODE 0#0e4W,i'gAg.:iti~* .• . c•:,LifLOTSIZE **VMv, Mg *om4
'ZONING DESIGNATION• * .'14BUILDING SHELL ONLY? ad:YES;�.,❑ NO v�
COMP PLAN DESIGNATION t , #4 4�*4 =BASIC PLAN? ho YES ," ❑,NO ``
SECTION: ,; TOWNSHIP_ =' GRANGE NEW ADDRESS REQUIRED? ,. g,_:❑YES ❑ NO
PLATTED LOT? "❑YES o N0 ' : � 'CHANGE OF USE? .gam% .❑YES =o'
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