01-104834 City of Federal Way Electrical Permit #:01 - 104834 - 00 - EL
Community Development Services � �
33530 I st Way S
Federal Way,WA 98003-6210
Ph:253 661 4000 Fax:253.661.4129 Inspection request line: 253.835.3050
•
Project Name: DRANGSHOLT
Project Address: 200 SW 292ND 5t Parcel Number: 119600 4870
Project Description: ELE-Altering 2 existing circuits for addition. This permit to final out expired permit ELE99-0480.
Owner Applicant Contractor
Mark T Drangsholt MARK DRANGSHOLT CEDAR RIVER ELECTRIC,INC.
200 SOUTH 292ND ST 21629 SE 245TH ST
FEDERAL WAY WA 98032 MAPLE VALLEY WA 98038
(425)432-5834
Electrical Fixtures
''_ l7 scription- i ! ; ' antity Description Description ;Quantity
Circuits-Residential 2
PERMIT EXPIRES June 18,2002,IF NO WORK IS STARTED.
Permit issued on December 20,2001
IIII 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: a'" ✓�f1 i Date: /2- 2 o_- O
C) ? S
is
7 #- ° 1N/ CONSTRUCTION PERMIT APPLICATION
i_ APPLICATION NUMBER: Q 1 — 1 Qi — EL
DEC 2 0 2flfi APPLICATION NUMBER: — —
u, I`LL ' i taL WAY 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
SITE ADDRESS: Z U 0 S " 2 3z"Vi ASSESSOR'S TAX/PARCEL#: / / cI 6 O 0 - 'f E? 7 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): _.
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING o MECHANICAL o DEMOLITION
X ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
P •
PROJECT DESCRIPTI (P Ovide detailed description): Ali// % 5 1 / / • ,„
4 ell •. ,12r' ) a/ ' i 1,
aipir pini I a 18
PROJECT NAME: Lb I I lipl&
• PEOPLE INFORMATION
PROPERTY OWNER:' NAME: MA Jp/‹ {�& }A / /A 0 L 7- DAYTIME PHONE:
(20Z. ) SYS - 20 341
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
6OX s4-//7 S— ROo,v t,✓' ,8105-Y
CONTRACTOR' NAME: DAYTIME PHONE:
,''I(1K /4/( // 7 CoNs7Ye(Ac7icA/ ( yzc) 'R2 - Ciriz
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
Oil)t Ofi PO /j dk 5-8 9 ( ) S,— -
CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FFAX NUMBER: -
V /11_►•�/'�V`� CONTRACTOR'S REGISTRATION NUMBER: /� I �/ /� A r EXPIRATION DATE:
0 V (copy of card required) /' C ,K I! C * I Z j ,& / /
APPLICANT: NAME: DAYTIME PHONE:
/)', 1 b /6s--1-{0 L7 (206 ) S-'17 - 20P/
I
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( zs3 ) y3� - 321/V
RELATIONSHIP TO PROJECT: FAX NUMBER:
o ARCHITECT a 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 to HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN 0 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: o ELECTRIC o 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 suppliedto the city as a part of thisapplication.application.
NAME/TITLE: �,' " C� � -3
1, 1 / _ DATE: f 2(20/0/
(e PROPERTY OWNER o APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
o NEW ❑ADDITION ❑ ALTERATION o 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
PLAITED LOT? o YES ❑ NO CHANGE OF USE? ❑YES o NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129