07-102190 4
City ofFedpmentS Electrical Permit #• 07-102190-00-EL
Community Development Services •
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: DR DUANE JONES-DENTISTS
Project Address: 33507 9TH AVE S Bldg E Pa cel Number: 926500 0020
Project Description: Installation of(2)t-stats
Owner Applicant Contractor
DUANE L JONES DDS EVERGREEN REFRIGERATION LLC EVERGREEN REFRIGERATION LLC
1706 S 320TH (ELECTRICAL) (ELECTRICAL)
FEDERAL WAY WA 98003 EVERGREEN REFRIGERATION EVERGRL957R9(1/15/08)
727 S KENYON ST EVERGREEN ATION
•
SEATTLE WA 98108 727 S KENYONREFRIGERST
SEATTLE WA 98108
J
Additional Permit Information
Electrical Fixtures
Thermostat.. 2
PERMIT EXPIRES Sunday, November 18, 2007
Permit Issued on Tuesday,`May 22, 2007
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 in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
/Z,2 70 '7
Owner or agent: Date:
THIS CARD IS TO REMAIN ON-SITE •
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 07-102190-00-EL
Owner: DUANE L JONES DDS
Address: 33507 9TH AVE S Bldg E
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections
are logged on the back of this card.
❑ Slab/Concrete Floor(4255) ❑ Ditch cover(4030) ❑ Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) ❑ Service(4235) ❑ Feeders/Sub-panels(4045) s1
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) 0 Ceiling Cover(4020) 0 Final-Electrical(4055)
Approved Approved Approved
By C ,) Date Q, By C `ta.).- Date L_c tel By 0.—‘ Date fs tl_c -ti .
❑ Under-slab groundwork(4295)
Approved
By Date
_ For inspector reference only
❑ Rough Electrical 0 FINAL-Electrical
Approved Approved
By bate By Date
RECEIVED ;,
APR 2 3 2007
Federal Way P w 0'` ` •L WAY
• p SF MF CO MED PL DE EN FP
COMVUATTY DEVELOPMENT SERVICES PT. ` ',
3332FEDERAAVENUE AY.WA 980 O BO971 9713 APPLICATION � ✓ �
FEDERAL WAY.WA 98063-9718
253-835-2607•FAX 253-835-2609
I'
The following is re.aired information-an incom.tete a..iication will not be acce.ted. Please .rint legibi (in ink)or ty.e.
p S L
• PROPERTY INFORMATION (,
SITE ADDRESS °"='S 01 ¶11 ' ka€- ' SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ LOT SIZE(sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description/
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit on/u)
Z T—A-u f-- S
PROJECT NAME(Name of Business or Owner Last Name) )a- O i SUr\Q c
• PEOPLE INFORMATION
PROPERTY NAME , PRIMARY PHONE
OWNER Ot.�'K� L- 3ene.S DO 5 ( )
MAILING ADDRESS CITY,STATE,ZIP
t-t t42 S 1/401 5 4 . ktr4. l try , uvA- 4 Z ci '
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
54vgrtio, (lbw sq.z(e+to) vii —r Wit (-L )1ta3 - 17•4N
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
-z7 S. W1i01 Vit. 5tR44-j z iNi3- 47 w 7 ( v ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER - 7
L O — ° w — k. V k l'\ I 1 B L / / (i.Cl& )1Q-5 - z el
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
'c u 6 V. 61 i2- I.- 4 5 1 a= 9 1, / 1 S /brl
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
0/1/4 WA,d\ Peitle cj iA f s'ta p&.> Tovie- (-2-61k2 ) 7V 3 - 11 Lt 11
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
1/1 SS VZ PROJECT tvroiN
t f�U +46 l�'
REFAX NUMBER
❑Architect ❑ Tenant ❑Agent 0 Other(Describe) ( S"'2,
t ) / -1-3 g4.
CONTACT NAM(; PRIMARY PHONE E-MAIL ADDRESS
' idY./{- (Tu() ),1,3 - «N
LENDER ,,,,'-nP,-,1Peit RC1f�I9'C2 O9e ender cn Tmatrun cs ; NAME
id ifproject value ezceed�,$5 OOO'� v
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ.FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTA4 EXISTING 6F TOTAL PROPOSED SF TOTAL SP
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS
FIREPLACE INSERTS
FANS HOODS(commercial) WOODSTOVES
BOILERS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(o Tub/snowel co nto)
SINKS
SHOWERS WATER CLOSETS(mile)
(Describe)
DISHWASHERS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 the city, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLEif\;. -,
DATE � /O 1
i�nature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner Agent (Contractor ❑Architect ❑ Other
IN_G. SHESLL)O1N ::
EteRIAH
SANPLA ) IMPROVEM` NTao-
YES
,n ;EPAR aTEANaYESa;NO . ,ROFCEU ' z ,f � AITEuRAT(01o _._ N ' ;r . . x [ S kaDDITO ..::i:,>7,:15'a_ ._ a , 01� . BG' a YE ,aNOaEW . ,. ;6YES NO ._ CGE OFUSE2 gsEa NOBUILION UPjSEALU : _= � oNO ZOING DESIGNAT , YS NO ; ,N . Ts1 RED? YEARSS REQUIRED? a i DEMOREMRESTEWDENO o ESp.PLATTED OTx
Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts�Pernut Application