01-101763 City of Federal Way
Community Development Services Electrical Permit #:01 - 101763 - 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: TACO BELL/PIZZA HUT
Project Address: 2031 SW CAMPUS Df Parcel Number: 242103 9102
Project Description: ELE-Electrical for three wall signs
Owner Applicant Contractor
NORTHWESTERN RESTAURANTS,INC. NONE CULBERTSON SIGN SERVICE
31919 1ST AVE S#206 CULBERTSON SIGN SERVICE
FEDERAL WAY,WA 213 FRONTAGE RD S
98003 NONE (800)925-6011
Electrical Fixtures
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Sign 3
PERMIT EXPIRES November 6,2001,IF NO WORK IS STARTED.
Permit issued on May 10,2001
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: Ct.?v' Date: 04 / 0 - 0
�•. 'CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: 01 - L~�I-1}66 - L.
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—,--._'-r rk if F[) APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
�**The following" ir®deAnf� �iton—Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems_ eering permits may require a separate application.
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u PROPERTY INFORMATION
SITE ADDRESS: 03 vJ _v , ../..o ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
r. ■ PROSECT INFORMATIr"
TYPE OF PROJECT(This application): El BUILDING ❑ PL :ING I MECHA AL ❑ DEMOLITION
$ELECTRICAL ❑ ENGI RING, FIRE PRE NTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): osoc A; . uk-)0.l\ S\Q Vl c,
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PROJECT NAME:
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■ P. 1PLE INFORMATION IllIllhk
NI.PROPERTY OWNER: NA D ME PHONE:
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MAADORE , - ATE,ZIP): -
CONTRACT* . NA DAYTIME P - E:
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NG ADDRESS(STREET •ESS; I(,STATE,ZIP): EVENING PHONE:
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OF FEDERAL WAY BUSINESS L ti SE NUM FAX NUMBER:
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CO OR'SGISTRATION NUMBER: ^ EXPIRATION DATE:
(copy o •required) -.- O a N a O' / a / a C)o a
APPLICANT' NAME: DAYTIME PHONE:
t Q &' p 1-)OW S ( )
MAILING ADDRESS(STREET AdDRESS;CITY,STATE,ZIP): EVENING PHONE:
`tea"'NA. ' ( ) -
RELATIONSHIP TO PROJECT: FAX NUMBER: I
❑ ARCHITECT CITENANT CIOTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS: -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT XONTRACTOR C51\-Z LeXS°•"SS C
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■ 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: ❑ LAKEHAVEN 0 HIGHLINE 0 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: ❑ 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: V �a v S\8 tn qQa .�,/1I DATE: 0 5 3 0
❑ PROPERTY OWNER ❑ APPLICANT ❑ 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 ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMI INITY OFVFI OPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129