01-100362 •
City of Federal Way Electrical Permit #:01 - 100362 - 00 - EL
Community Development Services
33530 1st Way S
Federal Way,WA 98003-6210 Inspection request line: 253.661.4140
Ph:253 661 4000 Fax:253.661.4129 (3:30pm cut-off for next day inspections)
Project Name: CHARBONNEAU
Project Address: 31425 28TH SRV PI SW Parcel Number: 150330 0240
Project Description: ELE-Add three outlets for remodel
Owner Applicant Contractor
MOLLY CHARBONNEAU NONE MOLLY CHARBONNEAU
31425 28TH PL SW 31425 28TH PL SW
FEDERAL WAY WA FEDERAL WAY WA 9'
98023
NONE (253)838-3887
Electrical Fixtures
Description Quahtity Description Quantity Description Quantity
Circuits-Residential 1
PERMIT EXPIRES July 28,2001,IF NO WORK IS STARTED.
Permit issued on January 29,2001
I hereby certify th• the above info •tion is correct a • ••t the construction on the above described property and
the occupancy a the use will be in ac•ordance wi • s,rules and regulations of the State of Washington and
the City of Fe.-ral Way.
or
Owner or ag:• : /11 � Date: j z-?(D 1
war:-
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CX;Of FIVEr) CONSTRUCTION PERMIT APPLICATION
VV I APPLICATION NUMBER: O I - J OQ 3 2 -EL
JAN 2 9 2001 APPLICATION NUMBER: -APPLICATION NUMBER: -**The followil CL I -1 W�tVormation-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.-
■ PROPERTY INFORMATION
SITE ADDRESS: 3 I{`LZS 2- fL ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLU IN r / M ICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGI E ' ❑ FIRE P*, ENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): /' \ NS< S
Nin)
PROJECT NAME: S--i•972. ► ' 1I . c w h1. <�*h/ r
A
■ PEO 1.E INFORMATION
PROPERTY OWNE• AME: AYnME PHON •:
-NiJcfrll• s3 ) g35 38 7i
MAI i !D ESS •EET ADDRE ITY QATE,ZIP)•
CONTRACT - V F DAYTIME PHONE:
L'(N/L,Q Or ( )
UNG ADDRESS(STREET ADDRESS;CITY,ST EVENING PHONE:
E
•° OF FEDERAL WAY BUSINESS LICENSE N ER: FAX NUMBER:
_ - ( )
CO • IRS REGISTRATION NUMBER: EXPIRATION DATE:
(copy of car.required) / /
APPLICANT: NAME: DAYTIME PHONE:
S a/wi , ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ 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? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY** '
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
■ PROSECT 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: DATE:
PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY: 1
❑ 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
CY1MMl wrTs ncVFl oPMFNT SFRVICFS•33530 FIRST WAY SOUTH•P.0 BOX 97IR•FFDFRAL WAY.WA 98063-9718•253-661-4000•FAX'753-661-4129