03-105509 City of Federal Way Electrical Permit #:03 - 105509 - 00 - EL
Community Development Services
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: ERNIE'S FUEL STOP
Project Address: 28727 PACIFIC S Parcel Number: 332204 9132
Project Description: Install new parking lot light.New conduit run to bldg.
Owner Applicant Contractor
REINHARD DISTRIBUTING CO FULLER ELECTRIC FULLER ELECTRIC
28727 PACIFIC HWY S FULLER ELECTRIC FULLER ELECTRIC
FEDERAL WAY WA 37107 12TH AVE S 37107 12TH AVE S
98003-3223 FEDERAL WAY WA 98003 (253)661-7181
Electrical Fixtures
Description Quantity Description ,Quantity Description 1Quantity
Circuits- Commercial 1
PERMIT EXPIRES June 19,2004.
Permit issued on I }.- A?..-4
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 accord ce with the laws,rules and regulations of the State of Washington and
the City of Federal
Owner or agent: CT's'(age-,a• Date: 42-2 7--O 3
---z- ko- c-D gk, :k_c_k_ e„er— fax-3 74 --- --f
Z 25- 4 Cerrv-ecf'0-t S GtS
1
t) \C“--t -F,,„SL -0( 0
14 D 1)
..
c..) : bk---, (7---;•7 /1 ,
1 F
CONSTRUCTION PERMIT APPLICATION
CITY OF /111"..."1+..of APPLICATION NUMBER: 03- 1 OS-509-oc
Federal Way CITY OF FEDERAL wavAPPLICATION NUMBER: _ _ _ -
BUILDING DEPT, —
fBERF
**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.
fact y� �/ ■ PROPERTY INFORMATION
SITE ADDRESS: 2.f 72 7 - T-?C t-4J7 I. ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
ERn«s Fug./ Slee
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑BUILDING ❑PLUMBING ❑MECHANICAL ❑DEMOLITION
LEECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
/few f 4tb.f 4f /',w,-. A/ei✓ eavetie Re 1 77 1/4
PROJECT NAME: E/ )1( J 1Z VD,
• PROJECT INFORMATION
PROPERTY OWNER: DAYTIME PHONE:
;en'c.s Fut] S¢Q, (231 )9V -//SLI
,2MAILING
t 7 7 ( gETD
ctc< s; yam ZIP):
, kr/ L✓li y f'80,02
CONTRACTOR:
/ / DAYTIME PHONE:
E!( fC ,.4 (223 )t..41 -7(gr/
•
G ADDRESS(STREET ADDRESS;CITY,STATE, EVENING PHONE:
37107 - 11�'"Apt , S ' tcoect4f 1Ja7 WA- /goof (2. 3 ) CG/ - 7 /et
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- 1 0 3 3 f - Q o (2s»C / - �95%
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) c L F E ,' O 2 Z ' K / / /2 I O1
APPLICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ARCHITECT 0 TENANT 0 OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT 0 CONTRACTOR
■ PROJECT INFORMATION
D ISTINGUSE: � " EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINIQERRED BUILDING? OYES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:OYES 0 NO
WATER SERVICE PROVIDER: ❑LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER.SERVICE PROVIDER: ❑LAICEHHAVEN 0 HIGHLINE ❑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: ❑ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) El ELECTRIC CI 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 cf such^'Lim),which may be made b;'a."'^er "., °^eluding the unde iced,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
a'/ - �� – z 3 o
NAME/TITLE: DATE:
❑PROPERTY OWNER 0 APPLICANT 'CONTRACTOR
iY.� -... ) ]l� (3 � 1 .. '1 � 1'7Y 91
7401 ; - 11._.. t ...'� _�J {,1 t 9
*al
• • _ ... -.Fr.'1—'• • % x �.}...r'-�+. °rG
-_ ..ti.• l I �",� l.'i1l\ _`I, i' 'f•{� 1- i"Ji�S •T l..J 57 S� � �1 i!
COMMUNITY DEVBAPMErIT SERVVICES►33534 FIRST WAY SO1�P0 BOX •FEDERAL WAY WA,9 s -9713.253.661-4000.
8063 •FAX:253-661-4129
_,;.;tv:-.p ' itk. :, '_ �^'r 'ti 'p1 - 1Rau -�se �S#'x in`.a+ x