04-104409 City ofFederalway
Community
Development Services Electrical Permit #: 04 - 104409 - 00 - EL
I? el
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection request line: (253) 835-3050
Ph:(253)835-7000 Fax:(253)835-2609 F •
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Project Name: THOREEN
Project Address: 30017 2ND$ CT Parcel Number: 891420 0110
Project Description: Addition of(1)circuit
Owner Applicant Contractor
Richard G Thoreen &Anne M Thoreen INTEGRITY ELECTRIC INC INTEGRITY ELECTRIC INC
4501 KENNEDY RD NE 4501 KENNEDY RD NE
TACOMA,WA TACOMA,WA
98422 (253)943-0500
Electrical Fixtures
Description Quantity Description Quantity Description ;Quantity
j Circuits-Residential 1
PERMIT EXPIRES April 25,2005.
Permit issued on October 27,2004
I hereby certify that the above information is correct and that tliie construction on the above described property and
the occupancy and the use will be in accordance with the laws,rales and regulations of the Slate of Washingto and
the City of Federal Way
Owner or agent: e� Date: 0rQ,\11-,6,11!\k
N
Ar
THIS CARD IS TO REMAIN ON-SITE
CITY of Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104409-00-EL
Owner: RICHARD G THOREEN
Address: 30017 2ND CT S
FEDERAL WAY, WA 98003-4302
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Slab/Concrete Floor(4255) �❑ Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) LEI Final-Electrical(4055)
Approved Approved Approved
1
By Date By Date By "4! Date (40\tY1
❑ Under-slab groundwork(4295)
Approved
By Date
Federal Way PERMIT
► COMMUNITY DEVELOPMENT SERVICES SF MF CO M IID PL DE EN FP
333268r"AVENUE SOUTH•POBOX 9718 APPLICATION FEDERAL WAY, 98063 D / /
253-835-2607•FAXX 253-835-260-260 9
unroll,.at yofederaluyatt com
The following is required information-an incomplete ap•lication will not be acce•ted. Please •rint legibly(in ink)or type.
'•> 1. . ■ PROPERTY DWORMATION
SITE ADDRESS SOD ) 1 2.r C c 4 c
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf7
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desenption)
'.- , - ■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of ork included on this permit only)
4J. , 1Th a GVC.-li A---
PROJECT NAME(Name of Business or Owner Last Name) `- l
• PEOPLE INFORMATION
PROPERTY NAME
OWNER C.- PRIMARY PHONE -
MAILING ADDRESS CITY,STATE,ZIP
3 0011 2„1 c+. S+. cle--,..-1 (Al v.>j (A/t nCe-3
CONTRACTOR COMPANY NAME APPLICANT NAMEOFFICE PHONE
r�
t vk - I e&1 v ale-rC ---5 T.--s (253 1 9 Lf 3 - 05 o b
MAILING ADDREST CITY,STA'11ZP CELL PHONE
q 5a( KP..,� p� . ,N T^c-o vvi-- w tq- qY'-1?r3- (153 -75e-$
CITY OF FEDERAL WAY BUSIN S LICENSE NUMBERIRATION DATE FAX NUMBER
- B L / / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE
-1 AIL e GE- Ta aNt"/ K-Pci /0(, .
APPLICANT COMPANY NAME APPLICANT NAME
rr__ OFFICE PHONE
�
Y "-5 O- CJ 0 N.— ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT • FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
r , G-sty- s ( s3 ) 143 - 05DD
LENDER PerRCW<19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
. ■ DETAILED BUILDING INFORMATION -
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN a HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) 4
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS '
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT r
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE) -
DECK(COVERED?)
GARAGE/CARPORT
^HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
•
FIXTURES _
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(comm«is1) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/ShowerCombo) SHOWERS WATER CLOSETS(ro,k, MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE B1BBS
LAVS(Bathroom Sulks) VACUUM BREAKERS ELECTRIC WATER HEATERS
. '< ':DISCLAIDIER/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 claim(including 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 claim
arises out of the reliance of the city,including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE r�
t✓�" DATE _ 1/0/7/1 V 11
turel (Title)
RELATIONSHIP TO PRO ❑ f. er 0 Agent Contractor 0 Architect ❑ Other
.
{ FOR OFFICE USE ONLY -
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? o YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—March 30,2004 — Page 2 of 4 k\I-landouts—Rcvised\Permit Application