01-103284 City of Federal Way
Community Development Services Electrical Permit #:01 - 103284 - 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: CITY OF FEDERAL WAY-PUBLIC WORKS
Project Address: G, t/ck._ Parcel Number: N/A
Project Description: ELE-Install underground service to provide power for school speed reduction flasher.
(ROW 35908 1ST AVENUE S)
Owner Applicant Contractor
CITY OF FEDERAL WAY *RICK PERI KING COUNTY ROAD SERVICES DIVISION CITY OF FEDERAL WAY *RICK PERI
33530 1ST WAYS 155 MONROE AVE 33530 1ST WAY S
FEDERAL WAY WA 98003 FEDERAL WAY WA FEDERAL WAY WA 98003
(253)661-4121
Electrical Fixtures
Description iQuantity ; . Description; IQuantity Description !Quantity
Service/Feeder: 0-100 amps-Comm. 1
PERMIT EXPIRES February 16,2002,IF NO WORK IS STARTED.
Permit issued on August 20,2001
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,
• / /
Owner or agent: , ' �,+� Date: (34L'cZ )
J--22 — G/
.441.
_ CONSTRUCTION PERMIT APPLICATION
VJED
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f � APPLICATION NUMBER: O / - ( (z 3,.Zk y -E(,
APPLICATION NUMBER: - -
vii BUILDING DEPTvHY 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.
- 1 ■ PROPERTY INFORMATION •
SITE ADDRESS q Q S 1 k\c- S . ASSESSOR'S TAX/PARCEL it: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
•
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING .0 MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERINGN FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 1 147161 .1/4)A hQ.bVt-lMD S L)ij c.
P(LoU l OC P0(,--Y.,-62 -a9-.-- c ctx., f.i Ci---'
PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: /u�` •LA) DAYTIM ' HONE: t �
MAILING ADDRESS(STREETA\-- ADDRESS;kYsrAT'E,ZPObt-`C v3V�, s (')5i)(101 -1-11a3 11a3
CITY, Q mak_ P
CONTRACTOR: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
Y OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
COI ACTOR'S REGISTRATION NUMBER: '1► EXPIRATION DATE:
(copy of card required) / /
APPLICANT: ME: DAYTIME PHONE:
k,+a,\G C0-0t. ) 4 O'- 1 P-pC.R"(L (ado) alp -slc33
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): \\ EVENING PHONE:
\ sr\o R PUS -v - �1-) . ( ) .
RELATIONSHIP TO PROJECT: FAX NUMBER: /
ID ARCHITECT CI TENANT ❑ OTHER(DESCRIBE): (yba
) b -0\75,
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT:NgI PROPERTY OWNER (APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
C
401.
**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 ❑ 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 only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information -•ppl•.d to� •ci as a part of this application. Q `
NAME/TITLE: I' •/ AO ' ' (ti ^� DATE: v ��J�l
El PROPERTY OWNER P. APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR El TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? El YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? El YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMI INrrY DFVFLOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY.WA 98063-9718•253-661-4000•FAX:753-661-4129