16-101937 Electrical
F ILE
City of Federal way Permit #:16-101937-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 F N PLE D
Project Name: CITY MD
Project Address: 31675 PACIFIC HWY S Parcel Number:082104 9077
Project Description: New electrical distribution,lighting,power and controls for tenant improvements.
Owner Applicant Contractor
CITY MD ANDY PAROLINEPAROLINE& SYSTEM SOLUTIONS OF WA INC
1345 AVENUE OF THE AMERICAS ASSOCIATES SYSTESW900PD (10/1/18)
NEW YORK NY 10105 3617 SW CHARLESTOWN ST p0 BOX 5308
SEATTLE WA 98126
LYNNWOOD WA 98046
Additional Permit Information
Is this an Online or O.T.C.application? No
Alt. Srvc/Feeder 0 to 200 amt 1
PERMIT EXPIRES Thursday,5 October,2017
Permit Issued on Wednesday,October 5,2016
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: Iv L,wv� Date: V)\611(0
\2 F NALED
LATE INSPECTOR AREA AND TYPE OF r SPECTION-
10- 63- t _Z tic :D4 - - cam.c 4 s4- n a c*
114`1 �� Cciti - t4� ROPY' Likriy+ X•Viil 0.044,
&-1-1 eY) e sce,_ 3
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s •
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 16 101937 00 Address: 31675 PACIFIC HWY S
Project: CITY MD FEDERAL WAY WA 98003-5407
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.
El UFER Ground(4295) ® Ditch cover(4030) El Slab/Concrete Floor(4255)
UFER Ground(4295) Ditch cover(4030) Slab/Concrete Floor(4255)
By Date By Date By Date
® Pool Bonding(4195) ® Temporary Power(4275) ® Service(4235)
Pool Bonding(4195) Temporary Power(4275) Service(4235)
By Date By • Date ,tux::.____- --- Date(l l(• (y
0 Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Feeders/Sub-panels(4045) Rough Electrical(4225) Ceiling Cover(4020)
By Date By Date By i Date (l'74 I
l
0 Final-Electrical(4055)
Final-Electrical(4055)
B e
yDate
fr
•
0 Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
CITY OF ,sELECTRICAL
APR 21 2016
Federal Way CrrvOF FEDERAL WAY PERMIT APPLICATION
7 CDS
PERMIT NUMBER /.6
_ o i 9 �j 7 _ e.,�. 5 /� /!!! ✓ SUITE/UNIT/SPA/CE#
SITE ADDRESS: 31675 Pacific Hwy S
PROJECT VALUATION ASSESSO ' T PARCEL# CURRENT/PROPOSED USE
35,500.00 0 / 0 LI - g 0 7 7-
PROJECT NAME City MD
(Tenant or Homeowner Last Name)
Interior remodel for walk-in clinic. New electrical distribution, lighting, power, controls
PROJECT DESCRIPTION per plan
Detailed description of work to
be included on this permit only
NAME City MD PRIMARY PHONE
PROPERTY OWNER (212 ) 913 - 0828
MAILING ADDRESS E-MAIL
1345 Ave of America citymd.com
CITY STATE ZIP FAX
NY NY 10105 ( ) -
NAME PRIMARY PHONE
TBD ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE it EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
Andrew Paroline (206 ) 719 _0339
APPLICANT MAILING ADDRESS E-MAIL
3617 SW Charlestown ST andy@parolineassociates.com
CITY STATE ZIP FAX
Seattle WA 98126 ( ) _
NAME PRIMARY PHONE
PROJECT CONTACT Same as applicant ( ) -
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 li on.
i
SIGNATURE: DATE 4/20/2016
PRINT NAME: Andrew Paroline
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application