01-102428 City of Federal Way
Community Development Services Electrical Permit #:01 - 102428 - 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: JACK IN THE BOX
Project Address: 31130 PACIFIC S Parcel Number: 785360 0186
Project Description: ELE-Modify up to(5)circuits for light fixtures and outlet relocation.
Owner Applicant Contractor
JACK IN THE BOX*ATTN:MANAGER* SOUTHGATE ELECTRIC INC SOUTHGATE ELECTRIC INC
JACK IN THE BOX 18940 DES MOINES WAY S#5 18940 DES MOINES WAY S#5
31130 PACIFIC HWY S 18940 DES MOINES WAY S#5 18940 DES MOINES WAY S#5
FEDERAL WAY WA 98003 SEATTLE WA 98148 (206)244-1570
Electrical Fixtures
'Description , '1Quantity ° Description jQuantityl -4Description ,IQuantity
Circuits- Commercial 5
PERMIT EXPIRES December 15,2001,IF NO WORK IS STARTED.
Permit issued on June 18,2001
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.
COwner oragent: Date: d
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M."0 9 {• CONSTRUCTION PERMIT APPLICATION
FSE KFIL— APPLICATION NUMBER: O / - L O �- _ k- _E .
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APPLICATION NUMBER: - -
tit+ , :_ ,,.-iNAY APPLICATION NUMBER: - -
BUiL D G 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 •
SITE ADDRESS: 3/ // P O ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTR SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION
JK ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
4
PROJECT DESCRIPTION(Pro ide detailed description): I, �, , �. ! _ 4
0 /
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME I DAYTIME PHONE:
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MAI I G,DI'E S(STREET ADDRESS•CITY,STATE P):
113O S
�I.9NTRACTOR: M�lNAM ` DAYTIME PHONE:
X06 )ONE
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.i G ADDRESS( ET ADDRESS;CITY,STATE, EVENING PHONE:
I r790
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eIF FEDERAL WAY BUSINESS LICENSE NUMBER: (
FAX NUMBER:
CONTRA REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) S Q 2 ist G- ,__ . G 6. _El
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APPLICANT: NAM'E:Ii ��pp pp p p DAYTIME PHONE:
MAI NG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EEVENING 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: 0 LAKEHAVEN 0 HIGHLINE Cl 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 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: A- DATE: 6 I Jrre->l
El 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? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMI INUV nFVFI OPMENT SERVICES-33530 FIRST WAY SOUTH-P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX: 253-661-4129