01-101644 J •
•
City of Federal Way
Community Development Services Electrical Permit #:01 - 101644 - 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: TESORO GAS STATION
Project Address: 1650 SW DASH POINT Rd. Parcel Number: 122103 9069
Project Description: ELE-Altering 2 circuits for hood and make up air
Owner Applicant Contractor
CITYBANK GOLD ELECTRICAL GOLD ELECTRICAL
5121 GALLEON DR NE 5121 GALLEON DR NE
TACOMA WA 98422 TACOMA WA 98422
(253)227-7712
Electrical Fixtures
Circuits- Commercial I 2
PERMIT EXPIRES October 23,2001,IF NO WORK IS STARTED.
Permit issued on April 26,2001
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: C , '‘ Date: / -/C2/
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Rough-in inspection:
Date
Service inspection:
Date
FINAL inspection:
Date
�. . ,,,,,5 CONSTRUCTION PERMIT APPLICATION
""" FA L APPLICATION NUMBER: DL - 10 L 6 - -ao.
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1 !c,'i*1\' APPLICATION NUMBER: -
r'"-:u iJ41-WAY APPLICATION NUMBER: - -
t'I Butt- v. 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: I(o 53 9W J1/I / f I? ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): -
'• ■ PROSECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBIN ❑ ANICAL ❑ D, OLITION
)ELECTRICAL ❑ ENGINEERI F ' •REVENTION S EM
PROJECT DESCRIPTION(Provide detailed de criptio
v oa .` - 6, 4/.e !.v
S
PROJECT NAME: S : / 0
PEW 'INFOR,-'TION
PROPERTY 0 R. NAME: DAYTIME PHONE:
MAILING •DDRESS - 'EETAr 5,'•"
CONTRA NA - DAYTIME PHONE:
e--�40 • C- /C CZ-3) 2-z7- 7?/Z
NG ADDRESS(STREET AD' ZIP): EVENING PHONE:
/2/ -a 0 P.e ''•. 9fu ( )
OF FEDERALWAYBUSINESS U NUMBER: - FAX NUMBER:
7.71-L--.:6104.
�7/ . .� BUi _ _ ... _ ( )
TRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
. ,z- Z/ Z3 / '
( .f card required) _ _ _ _
APPLICANT: NAM DAYTIME PHONE:
( ) -
ip
MAILING ADDRESS(STREET ADDR ,STATE,ZIP): - EVENING PHONE:
( ) -
RELATIONSHIP TO PROJECT. FAX NUMBER:
❑ ARCHITECT ❑ TENANT OTHER CRIBE): _ ( ) -
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: El YES Cl NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE El PRIVATE(SEPTIC)
- 1
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• . • • PRO]ECT 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. ��jj�
NAME/TITLE: � ��l �' : l
DATE: ` /4 7/e/
❑ PROPERTY OWNER ❑ LICANT , \ ON CTOR
FOR OFFICE USE ONLY:
El NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES Cl NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES Cl NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMI INm DFVFLOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129