01-101731 City of Federal Way
Community Development Services Electrical Permit #:01 - 101731 - 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: PHIL'S BIKE SHOP
Project Address: 2310 SW 336TH 5) Parcel Number: 132103 9097
Project Description: ELE-Installing wiring for new sign
Owner Applicant Contractor
TWIN LAKES VILLAGE LLC NONE CULBERTSON SIGN SERVICE
5108 MONTA VISTA DR E CULBERTSON SIGN SERVICE
EDGEWOOD WA 213 FRONTAGE RD S
98372-9250 NONE (800)925-6011
Electrical Fixtures
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APPLICATION NUMBER: Di - LC2 CI 1_ - Co
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'�C BWLOV-D Na*D*The following is required information APPLICATION
P ease NUMBER:
print(in nk)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• V4 PROPERTY INFORMATION
SITE ADDRESS: as 10 C •Lo • -;14. 41, S.,,;(- ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
' Ii PROJECT INFORMA ' A -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLU G I MECHANI, •L ❑ DEMOLITION
1:;I ELECTRICA ❑ ENGIN' •IN . FIRE PREV TION SYSTEM
I
PROJECT DESCRIPTION(Provide detailed des p. ): • • II,'
1
PROJECT NAME:
ailL
49 PES'LE INFO, NATION
PROPERTY OWNER: NAM DAYTIME PHONE:
( )
MAILING ' . •ESS(ST' ' AD:. .•IP):
AIM
CONT I OR: E: DAYTIME PHONE:
V• L! • "'� �� 5 the - ( )
MAILING ADDRESS( • ' ADDRESS; . ,STATE,ZIP): EVENING PHONE:
Z _ - I ( )
CITY OF FEDERAL WAY BUSI LICENSE NUMBER: FAX NUMBER:
_ - _ _ - _ _ ( )
CONTRACTOR'S REGISTRATION NU :ER: EXPIRATION DATE:
(copy of card required) 4 U L q. 0,.. 0 4- 7- N 2_ 8 / �.`L / 0 2.
APPLICANT: •
DAYTIME PHONE:
(?-c ) SZ� - t c,((
MAILING ADDRESS(STREET DRESS;CITY ,ZIall 11 / EVENING PHONE:
RELATIONSHIP TO PROJECT: ' FAX NUMBER:
❑ ARCHITECT ❑ ENAN 1 OT • (DESCRIBE ( )
E-MAIL ADDRESS:
,
CONTACT PERSON FOR THIS PROJECT: ❑ • •PE• ' •WNER )PPLICANT ❑ 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 ❑ 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
1
GARAGE
HOW MANY FLOORS? I,
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 Cl 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 aris ut of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplie the city as a art f this application.
— Z 2 90
NAME/TITLE: DATE: �
❑ PROPERTY OWNERPLICANT ❑ 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 El NO CHANGE OF USE? El YES ❑ NO
COMMI INITY f)FVFI OPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129