01-102699 City of Federal Way
Community Development Services Electrical Permit #:01 - 102699 - 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: HILDEBRAND
Project Address: 28913 5THt Avg S Parcel Number: 515298 0220
Project Description: ELE-Electrical for small addition-1 to 2 circuits
Owner Applicant Contractor
JANET HILDEBRAND NONE JANET HILDEBRAND
28913 5TH AVE S 28913 5TH AVE S
FEDERAL WAY WA FEDERAL WAY WA
NONE
r
•
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits-Residential 2 •
PERMIT EXPIRES January 5,2002,IF NO WORK IS STARTED. •
Permit issued on July 9,2001
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 Fe.-.
/
Owner or agent: i Date: � / 1
e y- 0/ M//
- / . vL), / �.
jits44)
CONSTRUCTION PERMIT APPLICATION
CR Of
•
�� - ic. APPLICATION NUMBER: Dt - D q --
' APPLICATION NUMBER: -
APPLICATION NUMBER: - -
U� Q � zi. •
**The foljowing is required information-Please print(in ink)or type**
Please note: Electrical, Fire Poy�e t ' +Hund Engineering permits may require a separate application.
2 G� `/ ■ PROPERTY INFORMATION - -
SITE ADDRESS: 2131 13 J1'`I L- S `W�`1 ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): �❑, BJU LDING CI PLUMBING ❑ MECHANICAL CI DEMOLITION
V
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Promo j'd etailed description :_AD 0 Ety_e_T k k.:. 1C1-1-L-
PROJECT NAME: k: _ as
• PEOPLE I iFORMATION
•
PROPERTY OWNER- AM ' a ..st N DAYTIME PHONE:
�1 t
L..-1%,.T3 rz.p- s_ (0- ) 30S -ob 88 1
..
MA G ADDRES:ST' I�•' OR SS;CITY,STATE�IP): '..
Wifft4
A
CONTRACTOR' NAME: 'E s 'DAYTIME PHONE:
n ( )
MAILIN''ODRESS(STREETADDRESS O'.:.,STATE,ZIP): < EVENING PHONE:
( )
OF FEDERAL WAY BUSINESS LICENSE NUMBER: _ - �, /:4 FAX NUMBER:
- — it -'': —r` r ' ( 'k) -
_
CON DR'S REGISTRATION NUMBER: r EXPIRATION DATE:
(copy of • equired) — — ; — \:_ —
APPLICANT: NAME - DAYTIME PHONE:
J: A&t T !-��be8 I (2) 3os -db A
MAILING AD.TcS( �AQD`ESGITY,STATE,ZIP): EVENING PHONE.
(216-- )946 - Z3S7
RELATIONSHIP TO PROJECT: /� A. (t FAX NUMBER:
17 ARCHITECT CI TENANT L7 OTHER
LU ki OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: XPROPERTY OWNER ❑ APPLICANT IRCONTRACTOR
• 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: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
{
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRO]ECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
I
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURE$
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 ❑ 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 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,rEr
my where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information tiplied t h-city as a 'art of this a.•lication.
NAME/TITLE: C /1 / I I I DATE: 7 ?f 0 1
l
L�3 PROPER OWN ❑ APPL CANT ❑ CONTRACTOR
/
FOROFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? Cl YES ❑ NO
COMM!INTTV of VFi OPMFNT SFRVICFS-33530 FIRST WAY col mi•P 0. BOX 9718•FFDFRAL WAY.WA 98063-9718•253-661-4000•FAX- 7C7-FF1-4179