01-104333 City Federal Way
Community Development Services Electrical Permit #:01 - 104333 - 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: DAMBORG
Project Address: 31714 11TH SO/ P' SW Parcel Number: 555730 0160
Project Description: ERLE-Add up to(4)circuits for addition.
Owner Applicant Contractor
Daniel A Damborg Daniel A Damborg WATTS ELECTRIC SERVICES INC
31714 11TH PL SW 31714 11 TH PL SW P.O.BOX 46410
FEDERAL WAY WA FEDERAL WAY WA SEATTLE WA 98106
98023-4719 98023-4719 (206)767-5111
Electrical Fixtures
DescriptionVA :Quantity iolk044,Description 'Quantity O„'i'`ugx.: Descri tion,,,,, k -.[Quantity
Circuits-Residential 4
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 W ill
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Owner or agent: •-s, I • Date: ` `
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G RECEIVEb CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: 0L - 16 .51• 3& L
�� �� NOV 48 2001 _
APPLICATION NUMBER: _ _',
CITY OF FEDERAL 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.
p ■ PROPERTY INFORMATION
SITE ADDRESS: 3117/'1 llin I L•, S C(J ASSESSOR'S TAX/PARCEL#:,5 J £ 7 3 O - O / , O
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
.. • PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BBUILDING 0 PLUM l► CHANICAL ❑ DEMOLITION
P ELECTRICAL ❑ GI; • NG❑ PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed descriptio L : E '!A 27 CA/ 0 zr/Y t/VC R cat)?
(ILOSF7 fi 0,77lfRo0
Q ,r
PROJECT NAME: R E , 0 1 ►9 L ` u ' -•
PE ',LE Il 'ORMATION
PROPERTY OW• •. NAME: ` DAYTIME PHONE
l ��Y RoRG 3
MAILING ADD•:.: STREET • a;CITY,STATE,ZIP): 'a
i7! / n r s (Al Ffpcanl tL/ ,- A 23
CONTRA • • E: DAYTIME PHONE:
{,Ur 77,S = iFc7R.7C_ (206) 767 -SW/
MAILING ADDRESS(STREET • i.RESS;CITY,STA ,ZIP): ' EVENING PHONE:
'_ .O,SOX 4 6 L// ) SF/7771 ti.) 1 r, ( ) -
• OF FEDERAL WAY BUSINESS LICENSE NUMiE• -` I . '- FAX NUMBER:
- ( ) -
in OR'S REGISTRATION NU .;: -41: , EXPIRATION DATE:
(copy .required) 11/ T r F S I 7 C Q K 11 /30 /,2o6/
APPLICANT: NAME: - DAYTIME PHONE:
( )
t MAILING ADDRESS(STREET ADDRESS;CITY,STA , ): EVENING PHONE:
( )
I 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: El LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 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) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC El GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC El 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(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such claim),which may be made by any person,inducting the undersigned,and filed against the City of
Federal Way,but only where such claim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplie to the 'ty as a part of this application.
NAME/TITLE: a 04 �W�- DATE: //q
IIS PROPERTY OWNER ❑ APPLICANT ❑CONTRACTOR
FOR OFFICE'USE ONLY:
❑ALTERATION TEN._
ANT
�� ❑ IMPROVEMENT ADDITION ❑"1tEPAIR
CENSUS CODE.:: -LOTSIZE
ZONING DESIGNATION , BUILDING SHELLONLY? ;_❑ YES ❑ NO
COMPP.L�AN DESIGNATION , . BASIC PLAN? YES` ❑i NO'
SECTION TOWNSHIP RANGE NEWADDRESSREQUIRED? ❑ YES El NO
PLATTED LOT? ❑ YES, El 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