01-101065 City of Federal Way
Community Development Services Electrical Permit #:01 - 101065 - 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: BAGDASAROV DENTAL OFFICE
Project Address: 33600 6TH rS S ite102 Parcel Number: 926480 0205
Project Description: EL-Install(10fcircuits for dental office.
Owner Applicant Contractor
YURIY BAGDASAROV UNIVERSAL ELECTRIC CO UNIVERSAL ELECTRIC CO
12550 GREENWOOD AVE N 301 6200 16TH AVE S 6200 16TH AVE S
SEATTLE WA SEATTLE WA 98108 SEATTLE WA 98108
(206)354-3932
Electrical Fixtures
t a Description Quantity Description 'Quantity Description [quantity
Circuits- Commercial 10
PERMIT EXPIRES September 16,2001,IF NO WORK IS STARTED.
Permit issued on March 20,2001
I hereby certify that the above information is collect 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 age • _ Date: /' V /exp
cr1
ur.or :-`EC:Er IVSD CONSTRUCTION PERMIT APPLICATION
� L' APPLICATION NUMBER: 0 1 - I O / 0 6 E-fir'
Fiv
MAR 2 0 2001 APPLICATION NUMBER: -APPLICATION NUMBER: - -
GI fY OF FEDERAL WAY
**The folio 4941 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: 2,j0 61 J(/V i lP ` " ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING • BING • ECHANICAL ❑ DEMOLITION
ZELECTRICAL E ERING❑ IRE PREVENTION` C
/SYSTEM
PROJECT DESCRIPTION(Provide detailed description): di)/ /I Co/15li/-M1)00A-i A, e ,c..40
PROJECT NAME: + , �� �� / C/ /
/A
■ F .0PLE INFORMI4. 'IN
PROPERTY OW R: NAME: DAYTIME PHONE:
b,
MAI NG ADD• (STRE DRESS;C ,STATE,ZIP):
CONT J AAMEv:�/J S 4 qri
fill
DAYTIMEPHONE:
a Va (STREET f/4/
+ / �� S / ( , ZI'): EVENING PHONE:
/CITY F FEDERAL WAY BUS LICENSENUMBER: .. .0, / ,, oh: 9803 7 CAX NUMBER:
( )
C CTOR'S REGISTRATION NU R: EXPIRATION DATE:
(copy of card required) j , e L/� ),2 — — — — / /
APPLICANT: NAME: I DAYTIME PHONE:
. ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
(
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 Cl NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE El PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT 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 claim(including 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 claim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
^/ I
� '.."`�-� lJli1��(
DATE: 3//e /, •2 °
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ 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•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129