01-103102 •
City of Federal Way
Cormnunity Development Services Electrical Permit #:0i - 103102 - 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: ROBINSON
Project Address: 31219 4TH SgP1 AJe$ J Parcel Number: 555750 0200
Project Description: ELE-Alter circuit for outlets and lighting in addition/remodel.
Owner Applicant Contractor
Norman&Carol Robinson NONE Norman&Carol Robinson
312194TH AVE SW 312194TH AVE SW
FEDERAL WAY WA FEDERAL WAY WA
98023-4638 NONE
•
Electrical Fixtures
Description 1Quantity Description 'Quantity Description (Quantity
Circuits-Residential 1
PERMIT EXPIRES February 3,2002,IF NO WORK IS STARTED.
Permit issued on August 7,2001
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 Wa .
/67 Owner or agent: / � �' Date: g /O
-/o - G/ G/- C��zr
�•« CONSTRUCTION PERMIT APPLICATION
� lEIVECO
0,APPLICATION NUMBER: t-- - / 23/ Q g
2001 Eiv
APPLICATION
NUMBER: - -
AUG APPLICATION NUMBER: - -
**The follQyviDg ii q 0.information-Please print(in ink)or type**
BUILDINta
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
- - - _. •- 1 PROPERTY INFORMATION -
SITE ADDRESS: 3121q Y f: 44-)e- 5 I-) . ASSESSOR'S TAX/PARCEL #: -
f LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): _
,r: - ■ PROTECT INFORMATION - . .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
® ELECTRICAL /�❑ ENGINEJERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): f/i- e( ba7A,^',04±:141,/ •e--1(' 1&d 6 a g
r
1
I
PROJECT NAME: /COb, -s o n
' - 1 PEOPLE INFORMATION - .. .
PROPERTY OWNER: NAME: DAYTIME PHONE:
` Nobi%.s o A ( =1.6-3 ) 839 -/oSil
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
Cts OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBE``"//R:
/I` •
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT' NAME: DAYTIME PHONE:
i6-74.4..)C.— i /‘,-,-5 /e4../ (2114)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): VENING PHONE:
31 1 5 l �� 6 l v p^1. /�C?ctc� LA--)P ' C2 f )) z55 I�3/
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT CITENANT CIOTHER(DESCRIBE): tr i c ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER A APPLICANT ❑ CONTRACTOR
. . ..•■ DETAILED BUILDING INFORMATION
EXISTING USE: 40-f-e1-1 e-- EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: 13n7-h 'r C-C`is-eiC`(2—_ PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: Cl LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ .PRO3EC,I,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 El GAS 1
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET i
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( ) i
INTERCEPTOR(S) SUMP(S)
- .. -E 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. DATE: g/7/0
❑ PROPERTY OWNER 'f APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR El TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES El NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES El NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO