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01-100978 A • City of Federal City ity Development Services Electrical Permit #:01 - 100978 - 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: DUBOISE Project Address: 2303 S 284TH P t Parcel Number: 422220 0110 Project Description: EL-Provide electrical service for addition. Owner Applicant Contractor Stephen J&Helen Duboise Stephen J&Helen Duboise Stephen J&Helen Duboise 2303 S 284TH PL 2303 S 284TH PL 2303 S 284TH PL FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA 98003-3210 98003-3210 :Electrical Fixtures Description .a 'Description (Quantity -Description Quantity Alt.Serv./Feeder:0 to 200 amps-Res.BM PERMIT EXPIRES September 8,2001,IF NO WORK IS STARTED. Permit issued on March 12,2001 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: ',c3cz Date: 3 / 3. a, o q- -G2- Of, N c-e ((� CITY Of �— �' �-° CONSTRUCTION PERMIT APPLICATION E� L APPLICATION NUMBER: L0 09 7F-- E,L- APPLICATION NUMBER: - - (;iiY O- t-CL3 i--AL WAY APPLICATION NUMBER: - - BUILDING DEPT. **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: "L'SO C 3 J 2$N I N ci)L^ ASSESSOR'S TAX/PARCEL #: - LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): r. ■ PROJECT INFL 'MAUL ' TYPE OF PROJECT(This application): ❑ BUILDING ❑ LUMB ❑ HANICAL I DEMOLITION I ELECTRICAL LI GINEE• ❑ FIR, REVEN ON SYSTEM PROJECT DESCRIPTION(Provide detailed descrip V / ►CR / 17 -11'11 so Ord PROJECT NAM. )U So e ■ 'EOPLL INFORMATION .. L MINIIIMMINNEMMEI AM PROPERT •WNER• NAME' ` DAYTIME PHONE: A _ — (ZS ) $3C) -7653 m. ING ADDRESS( ET ADORE' ITY,STATE,ZIP): . $l-ata Pt_ .1t.. 01 , - . 9$F. 1513 CONTRACTOR: AME: DAYTIME PHONE: 4-e2 %, O(c (z53 ) a34/- 7053 MAILING DRESS(STREET ADDR SS;CITY,STATE, EVENING PHONE: /r 3©3 5- -a 7`— ( ) - OF FEDERAL WAY BUSINESS UCEN 'U FAX NUMBER: r f — — — — — — — CONT4• OR'S REGISTRATION NU R: EXPIRATION DATE: (copy of card required) / / — APPLICANT: NAME: DAYTIME PHONE: ( ) 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 0 HIGHLINE 0 PRIVATE(SEPTIC) w ' w • . **NEW RESIDENTIAL CONSTRUCTION ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ ■ PROTECT 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 a part of this application. .13/12/3° ? NAME/TITLE: [5)4e,, i.411)BOf$� 00eler DATE: ✓ r2 d/ CI PROPERTY OWNER CI APPLICANT CI ON FOR OFFICE USE ONLY: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION: BUILDING SHELL ONLY? ❑ YES El 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 COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129