01-100520 A
City of Federal Way
Community Development Services Electrical Permit #:01 - 100520 - 00 - EL
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: MUTUAL INSURANCE SERVICE
Project Address: 1108 S 322ND P t Ln t (�' Parcel Number: 150260 0040
Project Description: ELE-Alteration of up to(5)circuits for(4)floor to ceiling power poles
Owner Applicant Contractor
Kathleen M Tiernan B&B ELECTRIC B&B ELECTRIC
2709 43RD ST NW 9815 31ST ST E 9815 31ST ST E
GIG HARBOR WA PUYALLUP WA 98371 PUYALLUP WA 98371
98335-1771 (253)840-3694
Electrical Fixtures
Description Quantity `° Description Quantity Description Quantity
Circuits- Commercial 2
PERMIT EXPIRES August 6,2001,IF NO WORK IS STARTED.
Permit issued on February 7,2001
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: ,j Date: 02- 7- O I
T a
CaisT Of CONSTRUCTION PERMIT APPLICATION
10)
uv _ , I.7\1 APPLICATION NUMBER: 01 -/ 15 -O - ��__
APPLICATION NUMBER: - -
t l\'°t;
® 1 NA P•1 t'° APPLICATION NUMBER: - -
**The following N id information-Please print(in ink)or type**
Please note: Electrical,Fi� pFF ton Systems and Engineering permits may require a separate application.-
•••• ■ PROPERTY INFORMATION -
SITE ADDRESS: I i Ocg. 3(7.,7 32Z ° rj ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PRO]ECT INFORMATION
TYPE OF PROJECT(This application): Cl BUILDING ❑ PLUMBI L G •NICAL 0 DEMOLITION
tid ELECTRICAL ❑ E INE ■ • REVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descrip, , • _ �.. „ - " Ay, y,A-
by
• -
PROJECT N• .
■ PEOPLE INFORMATION
PRO RTY OWNER: NAME: DA i ME PHONE: 4)2 lP j
)14/ 4.4 , 5 , 5eRvlcc_) ( -• ?1/ 1
MAILING ADD- (STREET ADDRESS;CITY,STATE,ZIP):
IIOS ` 3Z Q° PL
f
CONTRACT NAME 0 DA PHONE:
/✓(6 E)t.c, IC / U. ) 7u -ao5 y
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): y: EVENIN k ONE:
9V /5 31 s, ST E (45-3 Wo - 31.9
0 FEDERAL WA SINESS UCEN FAX NUMBER:
Ed c Cw V0c) — - — — ( )
CONTRA 'S REGISTRATION N ER: EXPIRATION DATE:
(copy of card required) 68 E�E * Dl C 13 - / /
— - -
APPLICANT: NAM • -i._ DAYTIME PHONE:
(ZS-5) 374 -Z'957"/
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
I$J5-- 3/ 5TH ( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT VI OTHER(DESCRIBE): 61-,f11.2f ,2. (-'25,)8 j - /56 I
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: 0 PROPERTY OWNER 0 APPLICANT IX 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 0 PRIVATE(SEPTIC)
a
**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: Cl 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)
■ C',.SCLAIMER/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 Cl CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION El 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 Cl NO
(YIMMI IIUTTV f1FVFI fPMFNIT SFRVICFS•33530 FIRST WAY SOIITH•P.O.BOX 971R•FEDERAL WAY.WA 98063-9718•253-661-4000•FAX:753-661-4129