01-104322 City of Federal Way
Community Development Services Electrical Permit #:01 - 104322 - 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: DASH POINT VILLAGE
Project Address: 1614 SW DASH POINT ft d Parcel Number: 122013 9074
Project Description: ELE-Installing new T-stat&wiring
Owner Applicant - Contractor
DASH POINT VILLAGE SYSTEM HEATING&A/C CO.,INC SYSTEM HEATING&A/C CO.,INC
1640 SW DASH POINT RD 9410 DELRIDGE WAY SW 9410 DELRIDGE WAY SW
FEDERAL WAY WA 98023 SEATTLE WA 98106 SEATTLE WA 98106
(206)762-4249
Electrical Fixtures
Mgl( RtitY DeScri tio11 li ntit
Thermostat
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 Date: /7—c=9:----
i� _Erz�L (a� . ' CONSTRUCTIONS RMIT APPLICATION
HY APPLICATION NUMBER: _ (,.% L (/(1
ECE!V APPLICATION NUMBER: _ -
APPLICATION NUMBER: _ _
ecAn^cam\ ..Twopoeiel laggiired information-Please print(in ink)or type**99 /o4 9b 7 Gc.G a0,
Please note: Electro t tion Systems and Engineering permits may require a separate application.
tflA Y
is PROPERTY INFORMATION
SITE ADDRESS: // IcDas i POI 4JASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OPSUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
, P: PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEM•
ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTIO .
PROJECT DESCRIPTION(Provide detailed description): I l'i S41/ �.S frc t /!/
PROJECT NAME: /J(2 i - t f/('/fes 5 e
. - PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
)(st€w► //e&f l hs5t 14. Cr (a4) 76a - 44./44-9_
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
14!® P e/r" w r.S Le, Sec,// w,ri, 98106 C ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) S ,� /0 / / Oa-
APPLICANT: NAME: DAYTIME PHONE:
I w► E<</ec tom- c ) S1
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
1)e/i'oye S6/ pp /Q /W ( SO/
RELATIONSHIP FAX NUMBER
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
71 DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
A
**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:
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 0 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) UMP(S)
ii. DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury tha 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 claim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application. r
NAME/TITLE: J a'1/L e.5 I /es fOYV J Y) ' DATE: L l— g--(2 f
0 PROPERTY OWNER APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ADDITION ❑ ALTERATION ❑REPAIR - TENANT IMPROVEMENT-
CENSUS.CODE: • 'tOTSIZE
•
,ZONING DESIGNATION „ BUILDING SHELL ONLY? •S.:1:1 YES ❑ NO ! -
. ;COMP P.AN DESIGNATION BASIC°PLANS ❑YES" 'Cl NO'
SECTION, TOWNSHIP RANGE NEW ADDRESS:REQUIRED? ❑•YES ❑=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:253-661-4129