01-102323 City Federal Way
Community Development Services r Electrical Permit #:01 - 102323 - 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: FAY
Project Address: 32812 12TH OV/We. 5 Ind Parcel Number: 926494 1010
Project Description: ELE-Alter(3)circuits for kitchen remodel.
Owner Applicant Contractor
Michael W&Maureen K Fay Michael W&Maureen K Fay Michael W&Maureen K Fay
32812 12TH AVE SW 32812 12TH AVE SW 32812 12TH AVE SW
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
98023-5203 98023-5203
Electrical Fixtures
'; ,' - ;Description - 'Quantity'Quantity "&".Description 'Quantity Description 'Quantity]
Circuits-Residential 3
PERMIT EXPIRES December 8,2001,IF NO WORK IS STARTED.
Permit issued on June 11,2001
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 ay. '
Owner or agent: / < '.7-7 Date:
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CATYOf G
RE IP
tr) CONSTRUCTION PERMIT APPLICATION
• E1JI E1zi�L
APPLICATION NUMBER: 04 - 1 () 23e73- L_-
uv FEY
Ji.ito 1 R (71,,,r,,'' APPLICATION NUMBER: - -
6:1 Y ter vvrS Y APPLICATION NUMBER: - -
BUILDING DEPT.
**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 •
328 / 2 �l iLl
SITE ADDRESS: /Z Av1 SM/ 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
ig ELECTRICAL
r,❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 174 7"'.z Di 4.
PROJECT NAME: FA
• PEOPLE INFORMATION
PROPERTY 0 1ER: NAME: DAYTIME PHONE:
/L-1 cls W PO/ (ZS1 ) S94 - oZ��
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
28/2 92'u A iX S -r---p0-e-pc<- GthirY /4/4 980Z
CONTRA -., NAME: DAYTIME-PHONE:
fri 1C AISC- LJ r/}Y (Z53 ) 574. - 62 S�
MA4NG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(S51 ) 838 - 6cSS2I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: # EXPIRATION DATE:
(copy of card required) — —
APPLICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,IIP); EVENING PHONE:
( )
RELATIONSHIP 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**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
- ■ :PROTECT 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: .--)1DATE: 6////0/
Nr PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ 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? Cl YES ❑ NO
PLATTED LOT? Cl YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
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