01-101574 4
City of Federal Way
CommuiityDeve1opment Services Electrical Permit #:01 - 101574 - 00 - EL
33530 1st WY S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: WORLD TAE KWON DO
Project Address: 32610 PACIFIC S SuiteB7Parcel Number: 162104 9025
Project Description: ELE-Alteration of up to(5)circuits for interior light fixtures.
Applicant Contractor
Owner
GOLD ELECTRICAL
KING COUNTY &TAE SON*KYONG SHON*
30165 3RD PL SW 5121 GALLEON DR NE
FEDERAL WAY WA 9: TACOMA WA 98422
(253)227-7712
.......Electrjpal Fixtures , ,,,
Quantity
lk,AIN tit 1:i,,PrreliOn,:;,, :
:-- Quaiiiiii ,7-7,1/4,;<*r,t,i , ,
,75.1 ,1E 0 6,,,,,,ii- -::0:ilitio (:)i '
lk
Description ---":. rTh
Circuits- C §e ommercial i:::iflir :ir*:*•:!:ie::::
WORK IS STARTED. ......,
2001,IF NO ..... : ...
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.... • .-- "x ---- ukitaWalitit A0 400-m,
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I hereby certify : i the ontrcflnon the
e
that
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the occupancy andool;torli:.:i.
rnad
the City of Federal W4tig,„IiP:T!!1:;:i!..7..!.... .. xis.
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owner or agent: .'il!:!i! ....-. .':1,,.. Date: /97c,
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�•Of G_ I - - ;_i,I� CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: 0L - (-‘94r2V2 00-62_
\)\> FiY� _ 1
ApR 1 q j APPLICATION NUMBER: - -
APPLICATION NUMBER: -
)Fl1-LOLc sL WAY
**The��I I a d information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
' • PROPERTY INFORMATION •
26/d p4c" "C S' -4( 67
SITE ADDRESS: "": 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 ❑ ENGINEERIN t I FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION( rovide detailed descrip 'on): -
/A/5l"c+\// g / - f ocic /Z eek .
fees2 Al -�
PROJECT NAME:
■ PEOF E INFG ATION
PROPERTY OWN" . NAME: ko ME .NE:
MAILING ADDRESS ET ADDR' ATE,ZIP):
•
CONTRA. 1 NAME: ,,/ III" 4 + PHO
'
M• G ADDRESS(STREET ADDR - CITY,STA ZIP): PHONE:
..512-( 6a//e- - .• ,' r (- • ') -
1 OF FEDERAL WAY BUSINESS LICEN UMBER: FAX NUMBER:
- _ — ) -
CO •CTOR'S REGISTRATION NUMBER: XPIRATION DATE:
(copy. -rd required) 6; _ ' .1 I C j : — _ '.2.--l z / d
APPLICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
El 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? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN 0 HIGHUNE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHUNE 0 PRIVATE(SEPTIC)
.01116
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• ■ PRO3ECT 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 suppli•. to the city as a part of this appl• ion.
NAME/TITLE: L i o DATE: � /
❑ PROPERTY OWNER `rPPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW' ❑ ADDITION ❑ ALTERATION ❑ REPAIR 0 TENANT IMPROVEMENT
CENSUS CODE: , LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? 0 YES . ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES 0 NO
PLATTED LOT? 0 YES ❑ NO CHANGE OF USE? ❑ YES 0 NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129