13-102742 }
411 'Electrical
City of Federal Way
Econ.
Community&Ecron.Dev.Services Permit #: 13-102742-00-EL
33325 8th Ave S F x
Federal Way,WA 98003 Line:
Ph:(253)835-2807 Fax:(253)835-2809 g 4 inspection Request (253)835-3050
Project Name: KOHL'S
Project Address: 2101 S COMMONS Parcel Number. 762240 0010
Project Description: Underslab wiring for 9 electrical boxes.
Owner Applicant Contractor
JAMES PALDA S D DEACON CORD OF WASHINGTON EVERGREEN ELECTRICAL SYSTEMS
STEADFAST COMMERCIAL PROPERTIES 2375 130TH NE SUITE 200 EVERGES904CH(2/13/14)
18100 VON KARMAN SUITE 500 BELLEVUE WA 98009 1900 W NICKERSON ST SUITE 116-9
IRVINE CA 92612 SEATTLE WA 98119
Additional Permit information
Is this an Online or O.T.C.application') Yes Is Use Educational or Institutional') No
Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial. 9
PERMIT EXPIRES Tuesday, December 17, 2013
Permit Issued on Thursday, June 20, 2013
li 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.
9 . r► %�
Owner or agent Date: �/
t �
\p„.
, THIS CARD IS TO REMAIN ON-SITE
CITY +' Construction I ection Record " `
Way Federal Wa • INSPECTION REQUESTS: (253)835-3050
PERMIT#: 13-102742-00-EL Address: 2101 S COMMONS
Project: JAMES PALDA FEDERAL WAY, WA 98003
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.
O UFER Ground(4295) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By CN Date q 1p By Date
Vat,/ . .
O Pool Bonding(4195) 0 Temporary Power(4275) 0. Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Dat B
Y Y -r By Date
�fil _ 1 1 1`?� .
Q Final-Electrical(4055)
Approved
By A � Date n— 1— C'.
O Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
• •
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III
CITY OF ''`• RECEIVED EL CTRICAL
Federal Way JUN 2 o 2013 PERMIT APPLICATION
FE
PERMIT NUMBER — iCT3 C,`5 CpIVICWAY —
SUITE/UNIT/SPACE t
SITE ADDRESS: 0 ( $• Co m a(
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ -7 6 a- y 0 - 0 0 l 0
PROJECT NAME s
(Tenant or Homeowner Last Name) / I
PROJECT DESCRIPTION t- .— 9 4i `9 O.?i
Detailed description of work to
be included on this permit only
ME PRIMARY PHONE
NA
PROPERTY OWNER Si" ' ' • 4q4 f (4404— ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
NAME PRIMARY PHONE
II' /�FStVj4�� C 'l� i S ( )
MAILING ADD
E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE I ZIP
I FAX( )
WA STA O 8'S ENSE 9 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE i
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( EMAIL
CITY I STATE ZIP FAX
• 1 ( ) -
PRIMARY PHONE
NAM196LAL„...it ( )PROJECT CONTACT
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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.
II _�I
SIGNATURE: �VI* DATE G/g0)1
PRINT NAME: D_ £d
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application