01-104592 City of Federal Way I Electrical Permit #:01 - 104592 - 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: HIGH POINT PARK 3/4
Project Address: 4210 SW 331ST PI Parcel Number: 327905 0040
Project Description: ELE-Install(1)low voltage thermostat in existing residence.
Owner Applicant Contractor
GURCHARAN SINGH MALHI NONE INDUSTRIAL COMM ELECTRIC INC
19239 117TH PL SE 4601 S 134TH PL
RENTON WA 98058 TUKWILA WA 98005
NONE (206)248-7900
Electrical Fixtures
Description Quantity Description
CONSTRUCTION PERMIT APP ICATION.. ?-
APPLICATION NUMBER: (9Z - Q.,rZ- fe
RECEIVED APPLICATION NUMBER: - -
`� APPLICATION NUMBER: - -
**The f r 4�41)1 information-Please print(in ink)or type**
Please note: Electrical,�F�rB8,1rst1!(it and Engineering permits may require a separate application.
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• PROPERTY INFORMATION
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SITE ADDRESS: -T Jw 351577L, ASSESSOR'S TAX/PARCEL#: 3 Z 71 c9 O
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
43Iu { FA MtL " 'EES IDEM CL
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL o DEMOLITION
ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): INI S ALLI /i` C' aaHoS 1 ( T
PROJECT NAME: ( eeck.)!'o L C.0/V, LEU Cri O k
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: or DAYTIME PHONE: -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): J`
CONTRACTOR: NAME: DAYTIME PHONE:
Iki 1)u S1 RIA L C'O ME2LIA ( ) -c- rruso
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
-DKL (bA A665to3 ( ) -
CITY 0 FEDERAL WAY BUSINESS LICENSE NUMBER: I FAX NUMBER:
(act)alt-g-r79os
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
i
(copy of card required) I kJ j S 7 wN q 5 '{--(` (,, C3 / /O?
APPLICANT: NAME. A
I kit S 4 121 A L lJ��ma-i C�Y� �(I A� e-Ci C- (on)aL - e.5t)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
LI-GD( S (3 --Fw -
RELATIONSHIP TO PROJECT: FAX NUMBER: t� ,
o ARCHITECT ❑TENANT OTHER(DESCRIBE):�� LTD (fibCL
) a - ! S-
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER o APPLICANT o CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN o HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ 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 EVAPORATIVE GAS LOG(S) REFRIG.SYSTEM(S)
UNIT(S) COOLER(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 o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SYS.
DRINKING SHOWER(S) WASH MACHINE
FOUNTAIN(S) 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 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: b � ' c" > DATE: I
o PROPERTY OWNER ❑APPLICANT (CONTRACTOR
FOR OFFICE USE ONLY:
o NEW ❑ADDITION o ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? o YES o NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES o NO
PLATTED LOT? ❑YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO