01-103397 City of Federal Way
Community Development Services Electrical Permit #:01 - 103397 - 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: PAYNE
Project Address: 1411 SW DASH POINT Rd Parcel Number: 072104 9091
Project Description: ELE-Add(2)circuits for a washer and dryer.
Owner Applicant Contractor
TOM PAYNE ELECTRO SERVE ELECTRO SERVE
1411 SW DASH POINT RD 13456 SE.27TH PL#240 13456 SE.27TH PL#240
FEDERAL WAY WA BELLEVUE WA 98005 BELLEVUE WA 98005
(425)451-3358
Electrical Fixtures
Description. Quantity Description 'Quantity Description (Quantity
Circuits- Commercial 2
PERMIT EXPIRES February 24,2002,IF NO WORK IS STARTED.
Permit issued on August 28,2001
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: 2Q'-C- (
4FI—orryor
_ RECEIVED • CONSTRUCTION PERMIT APPLICATIONAPPLICATION NUMBER: Q - 1- ( 3 j ?-YA AUG 2 a 2p� APPLICATION NUMBER: - -
(.I IY OF FEDERAL WAY
BUILDING DEPT 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.
■ 'PROPERTY INFORMATION
SITE ADDRESS: \L\\\ c,W r L1`� LSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• `. ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
0 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): .C) 'aw`SF.) 2 2-C.0 V � fir- �Y.CV 4_
_.2_n A..,,. \‘CD Q \J--)c--ti.J2-v--C20,-c‘,i"\-
PROJECT NAME: ---K-tn'.'
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
(253 )s -24.2:::.
MAILING ADDRESS(STREET ADDRESS;CiT ATE,ZIP):
CONTRACTOR: NAME: DAYTIMEPHONE:
e Ve_c_ it) 'r"v e \ (� )4S`�E -s‘
MAILIN\A RESS;CITY,STAIL ZIP ,Z16.1, ^ EVENING NPHONE: -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: �J FAX NUMBER:
- - ( ) -
CONTRACTORS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAIZ DAYTIME PHONE:
t-4- d(C.Q ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
t RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: PROPERTY OW.111EI APPLICANT ❑ CONTRACTOR
IN 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: $
■ 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this a plication.
NAME/TITLE: .�x".c
❑ PROPERTY OWNER APPLICANT ❑ CONTRACTOR
'FOR OFFICE:USE ONLY:::•
0 ADDITION ❑ ALTERATION 2 El " ❑ TENANT IMPROVEMENT
CENSUSCODE: • LOT.SIZE ...
ZONING DESIGNATION; BUILDING SHELL ONLY? :❑YES .❑ NO _
COMP PLAN DESIGNATION BASIC PLAN? ❑YES " ❑'NO' •
SECTION =TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES '0,NO
PLATTED LOT? .': ❑ YES ❑ NO CHANGE OF USE? I. YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129