01-102129 City of Federal Way Electrical Permit #:01 - 102129 - 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: BERGSTROM
Project Address: 30735 21ST SW Ave- S W Parcel Number: 416760 0070
Project Description: ELE-Replace existing 200-amp panel.
Owner Applicant Contractor
ELAINE MARIE BERGSTROM WASHINGTON HOME REPAIR WASHINGTON HOME REPAIR
30735 21ST AVE SW P.O.BOX 66965 P.O.BOX 66965
FEDERAL WAY WA 98023 SEATTLE WA 98166-0965 SEATTLE WA 98166-0965
(206)431-1991
Electrical Fixtures
f t _ ,Descri•"tiat* 3 u Q(aan.', m =d Pescripti0n . n'" Quantity Deacript on AQuantity
Alt.Serv./Feeder:0 to 200 amps-Res. 1
PERMIT EXPIRES November 26,2001,IF NO WORK IS STARTED.
Permit issued on May 30,2001
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: -. p� Date: .c' 3 0 - 0/
•- t &--- �'/ j/• --,-7 S C'" -,',-Biot? '=-----
•
C - e c - ,-/ - j r /
2p,
•
CI;Of = r 1VED CONSTRUCTION PERMIT APPLICATION
v\> EI " APPLICATION NUMBER: O I - L O Z/ EL,
MAY 3 0 r91 APPLICATION NUMBER: - -
APPLICATION NUMBER: -
(,6Ir Ot- s' cALVA '
**The foll��b®l�q��(niinformation-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS: 3C7-13...S" g/ Sw ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERINGLI FIRE PREVENTION SYSTEM \
PROJECT DESCRIPTION(Provide detailed description): PA S f ' J OV�
P.-61,1'Na fJ 6 q ,/jl Z-;/<-(_ 6 & , I
PROJECT NAME: &G Sr 1 -o n'\
■ PL°)PL► iIFOR
PROPERTY OWNER: PHONE:
• ,�. , s-
9 - 9?ea
AILING ADDRE STREET• 'RESS; ZIP): 4
J7
CONTRACTOR: E: \ C' ME PHON :
MAIC. -DDRESS(STREET ADDRESS; STATE,ZIP): ING PHONE:
CITY OF ERAL WAY BUSINESS UCENSE NUMBER. '"" - UMBER:
_ _ _ - _ ) 4/37 - 9931
CONTRACTOR' •EGISTRATION NUMBER: EXPIRATION DATE:
Uk) a l l
(copy of card required) r
/ '_
-
APPLICANT: NAME: DAYTIME PHONE:
MAIUNG ADDRESS(STREET ADDRESS, ,STAT.. EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENA ❑ ' R(DES •IBE): ( )
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: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
NO 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 supplied to the city as a part of this application.
NAME/TITLE: •� PAZO l DATE: 5-J 3 0
❑ PROPERTY OWNER ❑ APPLICANT (1/ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl 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 Cl NO CHANGE OF USE? ❑ YES ❑ NO
!'nnanv morn/r r\,ci nnnnr=nlT CFRVICFC•1 S31 F1RCT WAY cni m1.P 0 ROY 271R•FFrFRAI WAY.WA 98063-9718•?S"i-F,F1-40no•FAY-7cz-FJ 1-4r 70