01-103474 City of Federal Way 1
Community Development Services Electrical Permit #:01 - 103474 - 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: QWEST
Project Address: 1005 SW 316TH P1 Parcel Number: 555730 0240
Project Description: ELE- 100 amp service and circuits for new Qwest cabinet adjaacent to 1005 SW 316th PL.
Owner Applicant Contractor
Daniel Ray&Laurie Kay Wagner CLOVER CREEK ELECTRIC CLOVER CREEK ELECTRIC
1005 SW 316TH PL 1413 CENTER ST 1413 CENTER ST
FEDERAL WAY WA TACOMA WA 98409 TACOMA WA 98409
98023-4534 (253)627-6648
Electrical Fixtures
-Description Quantity Description Quantity Description Quantity
Service/Feeder: 0-100 amps-Comm. 1
PERMIT EXPIRES March 4,2002,IF NO WORK IS STARTED.
Permit issued on September 5,2001
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: 6
CIT../Of
� CONSTRUCTION PERMIT APPLICATION
•MVV FrzFn_ RECEIVED APPLICATION NUMBER: 0/ - 1120 5/7 y-to=✓(---
APPLICATION NUMBER: -
SPP 1) 5 ?OM APPLICATION NUMBER: - -
**The follate s RAILiation—Please print(in ink)or type**
t I �F r tlnDIN DEPT.
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 11SL , ASSESSOR'S TAX/PARCEL #: 54 � �,- t')2 yG)
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- ■ PROJECT INFORMATION • -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
iwg ELECTRICAL 0 ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTIO (Provide detailed description): 1 _ .- c5 /:r.
- $i- 1e` 1es
PROJECT NAME: 61L-Li 'l
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
- 14/14- 1/1.• ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREETADDRESS;CITY,STATE,ZIP): EVENING PHONE:
- k
CITY F D WAY BUSINESSLICENSENUMBPL_ FAX
- ia.
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CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
X. (copy of card required) �( �LA ' IJ)"('&
APPLICANT: NAME: / DAYTIMEPHONE:
C ,47 ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(
RELATIONSHIP TO PROJECT: ,�,.,� " FAX NUMBER:
CI ARCHITECT ❑ TENANT 'LS' OTHER( DESCRIBE): � ITA i�= ( )
,_.,, � E-MAIL ADDRESS: -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT L`'I'CONTRACTOR
■ DETAILED BUILDING INFORMATION -
EXISTING USE: EXISTING BUILDING ASS SSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSER IALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES • FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ H e INE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEH• EN 0 HIGHLINE ❑ PRIVATE(SEPTIC)
**MEW 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: S A, /, DATE: ti
❑ PROPERTY OWNER•'PL LS ONTRACTOR
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 0 NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? 0 YES 0 NO
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