01-101023 City of Federal Way
Community Development Services Electrical Permit #:01 - 101023 - 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: COOMBER/ROGERS
Project Address: 29350 3RD S*/ Ave. $ W Parcel Number: 119600 1310
Project Description: EL-Install low-voltage security system.
Owner Applicant Contractor
TERRY JENSEN CONSTRUCTION CORP A S D SYSTEMS INC A S D SYSTEMS INC
TERRY JENSEN CONSTRUCTION CORP 314 182ND AVE E STE B 314 182ND AVE E STE B
P.O.BOX 1326 SUMNER WA 98390 SUMNER WA 98390
ISSAQUAH WA 98027-0058 (253)630-1047
Electrical Fixtures
Description Quanti Description 1Quantity ;,rf Description Quantity
Low Voltage Burgler Alarm-Residen 3300
PERMIT EXPIRES September 12,2001,IF NO WORK IS STARTED.
Permit issued on March 16,2001
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 y.
Owner or agent: AA: C I> `L;&L Date: 3- 1(0-0
�'011�1n! f7ECEIVE j, y
IMTV,RE,iEf_OPE,1F;tiTDEPARTMENT
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• Ca Of MAR 1- .5 20p1 CONSTRUC_1 ION PERMIT APPLICATION
Vv — APPLICATION NUMBER: Q 1 - t D1 0 23 - E�
f C":7APPLICATION NUMBER:
17-'6�'4lil Gtr=,� ,%i c, c;--)1 'CS APPLICATION NUMBER: - -
**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
SITE ADDRESS: I -�C- C1icf:- S i- ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
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AVII
. . .x. - . ■ PROJECT INFORMATIO ' .
1
TYPE OF PROJECT(This application): ❑ BUILDING ❑ • MBING • ECH• AL I D r •N
' ELECTRI' , ❑ E INEERING❑ RE PR' ENT JN SYSTE
PROJECT DESCRIPTION (Provide detailed description). N/111111( C'Lt.(✓"LE- ,1 SLIS L
PROJECT NAME:
as PEOPLE INFORMATION
PROPERTY • ER: NAME' DA E PHONE:
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ING ADDRESS(STR. ADDRE ,CITY,STATE, ): ''
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CONTRACTOR: NAME: ! DAYTIME PHONE:
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'ICING ADDRESS(STREET ADDR ;CITY, TE,ZIP): - EVENING PHONE:
14- `<< L,-e: C t.t i-) ( ) -
CITY OF FEDERAL WAY BUSINESS SE M FAX NUMBER:
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CONTRACTOR'S REGISTRATION NUMBER: .^ [) EXPIRATION DATE: j
(copy of card required) ! S- *. 0 k 1�-c C,. 7/ . .(. / 1).Z
APPLICANT: NAME: DAYTIME PHONE:
( ) ,
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT `COCONTRACTOR j
- - - ■ DETAILED BUILDING INFORMATION '
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
s
•
**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) ❑ ELECTRIC El 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 certifyunder penaltyof perjury that the information furnished by me is true and correct to the best of my knowledge,and
P r] ry
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: t i -tt-Iii' DATE:
❑ PROPERTY OWNER ❑ APPLICANT \s.- CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? El YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? El YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
r lMr,mir,/nc rcl CPMFMT GFDV% FG.iZS7f1 FrRCT WAY fill MI•P(1 ROY 971R•FFOFRAI.WAY.WA 98063-9718•253-661-4000•FAX-253-661-4129