01-104486 • A
City of Federal Way Electrical Permit #:01 - 104486 - 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: POVERTY BAY COFFEE HOUSE
Project Address: 1108 S 322ND pi Unt i- f t Parcel Number: 150260 0040
Project Description: ELE-Install 200 amp 3 phase 120/208 volt service and branch circuits as needed for tenant improvement
Owner Applicant Contractor
Kathleen M Tiernan EASY DOES IT ELECTRIC INC EASY DOES IT ELECTRIC INC
2709 43RD ST NW 17712 2ND ST E 17712 2ND ST E
GIG HARBOR WA SUMNER WA 98390 SUMNER WA 98390
98335-1771 (253)939-5065
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Electrical Fixtures
Cit ReM ( C 1C
Description Quantity j4 ', Description ' =- Quantity Description Quanfity
Service/Feeder: 101-200 amps-Comr 1
PERMIT EXPIRES May 20,2002,IF NO WORK IS STARTED.
Permit issued on November 21,2001
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:61.1.1.,441-,•"""ktiktA.41 Sly Date: ` A7/6/
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«na �- -C F, VED CONSTRUCTION PERMIT APPLICATION
�� RELIy L APPLICATION NUMBER: O l 1 0448 _ e...,
NOV 2 2001 1APPLICATION NUMBER - -
APPLICATION NUMBER: -
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' .:IIYOFFED AL — —.— — — — — —
**The fo1l Lgl�lllaeI�I ormation—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
_ 30.3
_ - '/V :PROPERTY INFORMATION
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ADDRESS: 1 10 . 2&' N L ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
,_ ., ; -`_t14,PROJECT INFORMATION .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM ‘6tic
,
PROJECT DESCRIPTION(Provide detailed description): C �V V t 3 P..,i(q,LiL / / O o (6,-(/
�.1112.)uf .L.R. e(.1 C cin_ S
PROJECT NAME: '� 'Z17-Ti1 T'4-y' • ' -r of
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_ . a P, "IPI"`..'NFOFIATION _
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PROP,ERTYOWNER• NAME: Igo
/// -`. DAYTIME PHONE:
r U (' i'DRESS;•/ -, •71 I M e (453) 333- '75—
MAIl1N
CONTRACTOR' NAME: - +4 E_ DAYTIME PHONE:
a Do €c_Tz t cr —4— ) ;39= 57165—
.; NG r e•-ip(SIRE =DRESS;CITY,STATE,ZIP): s < - .•ING PHONE:
4�
• OF FEDERAL -.Y BUSIN CENSE NUMBER: s. r FAX NUMBER:
CONTRACTOR'S• el ON NUMBS• :e.
EXPIRATION DATE:
(Dopy of cad required) ' d c� ` y r / /
1. / 0
— -4. _
APPLICANT: NAME DAYTIME PHONE: -
MAILING ADDRESS(STREET ADDRESS;CITY, -, IP): EVENING PHONE:
I ( )
!I RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
•13-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: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
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**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
BATHTUBS) 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 madeI
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 of the city,induding its officers and employees,upon the accuracy
of the information suppli to the city
as a part of this application. /
NAME/TITLE: (l) Lc.�/r 4 -4SJ'(,. DATE: /� ` A�
❑ PROPERTY OWNER ❑ APPLICANT 1k CONTRACTOR
- - I
FOR OFFICE.USE ONLY:f%
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,CENSUS'CODEEW ' . <.❑ADDITION ❑ALTERATION ❑,:REPAIR TENANT IMPROVEMENT
NLOT SIZE ,
ZONING ESIGNATIONI° BUILDING SHELL ONLY? _.❑YES ❑ NO _
pCOMP PLAN DESIGNATION BASIC PLAN? ❑ YES LINO'
,SECTIONSTOWNSHIP 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