01-104311 City of Federal Way Electrical Permit #:01 - 104311 - 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: HYUN CHIROPRACTIC&ACUPUNCTURE
Project Address: 31260 PACIFIC S Parcel Number: 092104 9265
Project Description: ELE-Relocating lighting,adding switch,putting in outlets
Owner Applicant Contractor
Plaza Lie Dana GOLD ELECTRICAL GOLD ELECTRICAL
31260 PACIFIC HWY S 5121 GALLEON DR NE 5121 GALLEON DR NE
FEDERAL WAY WA TACOMA WA 98422 TACOMA WA 98422
98003-5448 (253)224-4018
Electrical Fixtures
Description liPMPuantity :`,: ' Description 'Quantity -.Description Gl lantity
Alt.Serv./Feeder up to 200 amps-Col 1
PERMIT EXPIRES May 7,2002,IF NO WORK IS STARTED.
Permit issued on November 8,2001
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: /_—i C . _ Date: //A /e9
«�� G_ L ,. :a.- CONSTRUCTION PERMIT APPLICATION
uV APPLICATION NUMBER: D L' - i_ Q iS L I- -
RECEIVE r-1 APPLICATION NUMBER: _ _; _ _ _ - _
APPLICATION NUMBER: _ _ _ _ _ _ _ -
N B1120ki'l is required information-Please print(in ink)or type**
Please note: 6F a�Agv r jon Systems and Engineering permits may require a separate application.
_ ■ 'PROPERTY INFORMATION
SITE ADDRESS: ?/2-1CO /PA • 4/ ' -71, ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.r ■ PROSECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING " .4 ECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGIN - .I •REVENTION SYSTEM
•
PROJECT DESCRIPTION(Provide detailed de cription):
5e.e.) :711// /�Y� 9-/". ' /o ,Ajcr.CP BC i- �A = G�-42 ,
PROJECT NAME: g G-(7'/ It- jk'" C ' C /1 e ,- •
A. Ank
I F _ 'PLE IN. ..ATION
PROPERTY OWNER: NAME: XME PHO -
)
LING ADD'. • ET ADDRESS; a ,FATE, - -
NAME:
CONTRACT `.E PHONE:
G 'ESS;CITY,Y,,STATE,ZIP): . * ING• -
4N2/ • / ' 7�.0i' A gpe
)
QTY OF FEDERAL : SINESS LICENSE NUMBER: FAX : R:
- ( -
CONTRACTORS REGISTRA UMBER: EXPIRATION DATE:
(copy of card required) O 1 /I '! cf 2 23 / '2_
APPLICANT: E: DAYTIME PHONE:
( ) -
MAILI'- i DRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
E�P RELATIONSHIP TO PROJECT: FAX NUMBER:
\.)
j'1 ❑ 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: 0 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($) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: El ELECTRIC 1:1 GAS
PLUMBING
40
BATHTUB(S) LAVATORY(S) ¢ URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SH'OWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
4
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of myknowledge,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(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,including its officers and employees,upon the accuracy
of the information supplied to-the city as a part of this application.
NAME/TITLE: G JGca%G�'�dt7 . DATE: ///7 /�/
❑ PROPERTY OWNER P', C LICANT ❑ 'O / •CTOR
FOR OFFICE USE ONLY:
ElNEW; ❑ ADDITION - ❑ ALTERATION ❑:REPAIR'. ❑ TENANT IMPROVEMENT
CENSUS CODE: - r LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ".❑ YES El NO
COMP PLAN DESIGNATION BASIC PLAN? ❑YES " ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES El NO
PLATTED LOT? ❑ YES ❑'NO CHANGE,OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-6661-4129