17-101884 Electrical
CommunCity fFDeveloedera Permit #:17-101884-00-EL
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax(253)835-2609
Project Name: FEDERAL WAY MEDICAL DENTAL CENTER
Project Address: 1014 S 320TH ST Parcel Number:082104 9234
Project Description: Replace(20)existing luminaires with(20)new LED for PSE retrofit
Owner Applicant Contractor
FW MEDICAL-DENTAL GRP LLC ILLUMINATION SERVICES LLC ILLUMINATION SERVICES LLC
PO BOX 23314 10216 SE 256TH ST SUITE 103 ILLUMSL878M3(7/23/17)
FEDERAL WAY,WA 98093-0314 KENT WA 98030
10216 SE 256TH ST SUITE 103
KENT WA 98030
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Circuits Commercial rn x
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PERMIT EXPIRES Wednesday,25 April,2018
Permit Issued on Tuesday,April 25,2017
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
W shi gton and the City of Federal Way.Owner or agent: ( \ 'vt\C .
Date: "L
2 f7
•
THIS CARD IS TO REMAIN ON-SITE
Federal Wa Construction Inspection Record
Y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 101884 00 Address: 1014 S 320TH ST
Project: FW MEDICAL-DENTAL GRP LLC FEDERAL WAY WA 98003-5344
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 cc the inspection sequence. On-going inspections are logged on the back of this card.
•El UFER Ground(4295) „El Ditch cover(4030) „El Slab/Concrete Floor(4255) ,
Approved Approved Approved to place concrete
By Date By Date By Date
® Pool Bonding(4195) El Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
LLI Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055)
Approved
*CSC- Date cc-a 3--�
Rough Electrical 0Final Electrical E Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF
` RECEIVED ELECTRICAL
Federal Way APR 2 5 2017 PERMIT APPLICATION
CITY OF FEDERAL WAY \ 0 k 8 CJ 4 00
COMMUNITY DEVELOPMENT PERMIT NUMBER _
SITE ADDRESS: -µ SUITE/UNIT/SPACE#
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# � _ CURRENT/PROPOSED USE
$ 5 -o o8 Z I `O
PROJECT NAME
(Tenant or Homeowner Last Name) '4 Les- 1 r•cm5A. rro) herF C sh - L_c j* Q 4`i-
n
RaG2� p,t,' r-, l v rr:,-�ca, r e :- -1-�(26..") 25)
PROJECT DESCRIPTION (The Pc-E. Q
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER F-VV m c Cmc Lt c (,ob)' .1-1- 3c,
MAILING ADDRESS E-MAIL
CITY ,STATE ZIP `- FAX
orc� k
1 �oy_. CZt9,3-U31t--j
NAME PRIM PHONE
LLQ (20W20:..) -' tet(
MAILING ADDRESS E-MAIL
ELECTRICAL )o`Zt 5E 2�L, '-l-c 103 P ,3 r\rcL-kiV?i-1 n
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
TLLUrYTh5L M3 7 / /i?
NAME PRIMARY PHONE
APPLICANT p`r� Q C:-::+c C ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT (20i0)2.0,
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.
SIGNATURE: y\i\r\A\ ( _c4 DATE `ZS I-)
PRINT NAME: (Theo k
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application