01-102814 •
•
City munit FederalDWay Electrical Permit #:01 - 102814 - 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: HERMAN (=.06
Project Address: 33305 43RD SW Parcel Number: 142103 9043
Project Description: ELE-Hooking up electrical power to existing mobile home
Owner Applicant Contractor
Victor I Herman Victor I Herman Victor I Herman
8157 32ND AVE SW 8157 32ND AVE SW 8157 32ND AVE SW
SEATTLE WA SEATTLE WA SEATTLE WA
98126-3539 98126-3539 (206)841-2328
Electrical Fixtures
Description 'Quantity Description Quantity Description 'Quantity
Service or Feeder-Manu./Mobile Ho I
PERMIT EXPIRES January 14,2002,IF NO WORK IS STARTED.
Permit issued on July 18,2001
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 Way.
Owner or agent: . . Date: // /11 c/
4.„„, CONSTRUCTION PERMIT APPLIC TION
APPLICATION NUMBER:�Y�►��v�® APPLICATION NUMBER: � � - ��� � � ��I
ee`` 1 �� � APPLICATION NUMBER: - 11
-
4"1**The followin is required information-Please print(in ink)or type**
DERAL WAi
Please notiG►8ffilKeventi•n Systems and Engineering permits may require a separate application.
hi,
F\ PROPERTY INFORMATION '
3-330 0 z
SITE ADDRESS: �3 CI‘'� 3 Lei ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.• ►:I PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL • !EMOLITION
ATELECTRICA ❑ ENe EERING❑ FIRE PREVENTIO SYSTEM
PROJECT DESCRIPTION(Provid• •etailed descriptio
fill 1
PROJECT NAME: 11 '44-
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PROPERTY OW •
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37 vF7
• AILING ADDRESS(STREET ADDR. CITY, ,ZIP): T*.
/s7•-3z add_- $w S •
•„: -/7 _ A. /z..G
CONTRACTOR: E: 8AbiME PHO
1 C ter - ,Cl'/� .9e) 376yP,7
MAI. ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): +- EVNG PHONE:
d�i. 3" 7 3zs S.� . r /'L_c, ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: DAYTIME PHONE:
i'`o%' f ,l���C'�'1 04 ( ) a- w 3 .Sr-
LING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
fj 7_ 3 sec-, s,.-..�z, 4.:. z.,,,,-, ;'e 6-- ( )
RELA ONSHIP TO PROJECT: FAX NUMBER: •
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR '
■ 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**
I NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• • ' ■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT411
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
-DECK
•
GARAGE 1
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 ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
... 12 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 suupplied to the city as a part of this application. /
NAME/TITLE: de-r4"---2,---- •• •2-- CV-e_.--2
-A� DATE: /b/ �/
. PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION Cl 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? ❑ YES ❑ NO
COMMI INTTY nFVFLOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000-FAX: 753-661-4129