01-104186 City of Federal Way Electrical Permit #:01 - 104186 - 00 - EL
Community Development Services
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: HANSEN
Project Address: 410 SW 368TH 5+ Parcel Number: 302104 9086
Project Description: ELE-Relocate and add(2)circuits to existing serive.
Owner Applicant Contractor
Mark K&Suzanne E Hansen J R ELECTRIC CONSTRUCTION DESIGN IN' J R ELECTRIC CONSTRUCTION DESIGN IN/
410 SW 368TH ST 3716 42ND AVE NE 3716 42ND AVE NE
FEDERAL WAY WA TACOMA WA 98422 TACOMA WA 98422
98023-7357 (253)952-2081
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1 15 L( M la✓ tO-- I °11) v�S c i)-N f+— -
Electrical Fixtures
Description 464* _ u'anti Descr tion ty �H ODescriptian LQuantity
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Alt.Serv./Feeder:0 to 200 amps-Res. 1
PERMIT EXPIRES April 29,2002,IF NO WORK IS STARTED.
Permit issued on October 31,2001
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 i ccorda e with the laws,rules and regulations of the State of Washington and
the City of Federal 000 /
Owner or agent: Date: AO -5 0
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crl-Ncel�e� ( A� ST� ^ �o
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ErI.. !V 1 CONSTRUCTION PERMIT APPLICATION
�� mo— APPLICATION NUMBER: O I 1 C� /e - EL-
OCT 3 1 2091
APPLICATION NUMBER: - - _
LAI BUILDING DEPTVAY APPLICATION NUMBER: _ _ _ ._ _ _
**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: b S. 36Z-t-I -i 1 ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
,ELECTRICAL ❑ ENGINEERING El FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): r �,`�5,�'j►/�p� --
PROJECT NAME: PAC k.C' VNSOV\
- ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PH
c r c, ASO rte- ( ) 6
f Y1 / - 7Y9^9'
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
V/0 . 36 t-h j 7 sera lulty tic)?rti `L%tJ o 3
CONTRAC NAM ' DAYTIME PHONE:
(AfAlt- EZ-53) '(73-47T 7
NG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): PHONE:EVENING
7/4 ZEArA
`�.c.l&ri.&a- ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
(2.5'3) 56'-1
CONI ilCTOR5 REGISTRATION NUMBER: CC EXPIRATION DATE:
(copy of card required) L 00 .1b1
APPLICANT:
r jay C5 ( 3)Cl Z3 -6n7
MAILING ADDRESS STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
171E RELATIONSHIP TO PROJ w 7 r �� TV�Z& FAX NUMBER: q q
CI ARCHITECT CI TENANT CI OTHER(DESCRIBE): (j 3)y d S� - L 1
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: $
■ PRO3ECT 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) RANGES) 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),wh",. may be made by any person,induding the undersigned,and filed against the City of
Federal Way,bu on where such daim a - out of the reliance of the city,induding its officers and employees,upon the accuracy
of the informati.n s .plied to . city as jpart of this application. /
NAME/TITLE: / /A DATE: [ D—3 /- o
-
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
• FOROFFICE,USE ONLY:
ADDITION
❑ ALTERATION REPAIR ❑TENANT IMPROVEMENT
CENSUSCODE: "LOT,SIZE: ,
•
ZONING:DESIGNATION R BUILDING SHELL;ONLY?a"❑ YES ❑ NO ';
COMP PLAN DESIGNATION BASIG PLAN?
YES— ❑ NO•
SECTION "TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
;PLATTED LOT?:. ❑ YES CI CHANGE OF.USE?. ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 •