01-104348 rs
City of Federal Way Electrical Permit #:01 - 104348 - 00 - EL
Conununity 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: VALLEY RADIOLOGIST
Project Address: 181 S 333RDeite210 Parcel Number: 926500 0258
Project Description: ELE-Install ata and phone cabling for new tenant space.
Owner Applicant Contractor
VALLEY RADIOLOGISTS INC PS WARNER TELECOM GROUP WARNER TELECOM GROUP
POB 26730 803 SW 207TH PL 803 SW 207TH PL
FEDERAL WAY,WA NORMANDY PARK WA 98166 NORMANDY PARK WA 98166
98093 (206)793-8473
Electrical Fixtures
,` Descrlption /I' le Description QuantitY Description � antit
Y
Low Voltage-Other Commercial 2000
PERMIT EXPIRES May 12,2002,IF NO WORK IS STARTED.
Permit issued on November 13,2001
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: 124AE5-- Date: //- /3 -e3'1
1
R EC 1Vr
�� - CONSTRUCTION PERMIT APPLICATION
G
APPLICATION NUMBER: al - 1 CO t13g.�- EL-
�� -��>L. NOV 13 200
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.
/f1/
• PROPERTY INFORMATION
SITE ADDRESS: /75 SSJ)Gi ?i3ycIL ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PRO3ECT INFORMATION
TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING ❑ MECHANICAL ❑ DEMOLITION
'ELECTRICAL ❑ ENGINE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): y2, A if,,t b
n
PROJECT NAME: l7/91.1ey 4Dio,1_. s a .:
PEL-`LE INFORMATION
PROPERTY OWNER- NAME: E PHONE:
149- . -.i / h - ) 61,1 - /7(--)5
MAILING 7 LINGG AD' S( •. �. _• % • TE,Z
CONTRACT, AME: DAYTIME PHONE:
If
ono r 6.iP ) ( ) -
'ONG ADOBE`S.v ,Po,DRESS;C1TY,•
STATE,Z2�): ®Yo " . ',o /I9I fL Ly Jto (EVENING PHONE: -
• OF FEDERALL1 t!23 WAY BUSINESS LICENSE NUMBER: - ,c� FAX NUMBEEJR:
- - ( ) -
_
CO OR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) / /
APPLICANT: NAME: I� DAYTIME PHONE:
I 3-19`7),5 Jun Ir 0016 ) T3 - C(3/ 3MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
gC'3 5W do7>ItA a/ /1/GemmiDyny w/9 9�S/6C cam ) )) - 84'73
I RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): (P96 ) g70 - 002 Xs
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? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
ate Am,
**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(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 daim(induding 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 o.f the city,induding its officers and employees,upon the accuracy
of the information supplied to the city as apart of this application.
NAME/TITLE: )1S-J9 DATE: ?`
❑ PROPERTY 0 NER ❑ APPLICANT CONTRACTOR
•
FOROFFICE:.USE ONLY:
❑ NEW . ❑ADDITION ❑'ALTERATION ❑:REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE. .
ZONINGLAN DESIGNATION BUILDINGSHELL ONLY? ❑YES .❑ NO
COMP PDESIGNATION BASIC PLAN? _ ❑YES ❑ NO'
SECTION I.'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