11-104942 A. 1411 _ Jo4c2 1vu,
CITY OF 'lu
Federal Way ELECTRICAL RECEIVED
PERMIT APPLICATION
DEC 1 4 20°1
**Most electrical permits may be obtained on-line at www.cityoffedertytifsKtEDERAL WAY
PROPERTY INFORMATION (^DS
SITE ADDRESS: `7. 0 0 r 3 - /�4'11 Sr f
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PROJECT INFORMATION
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Detailed description of work to i
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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 irtformation 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.
Ifurther 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),whic may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises out of the re ce of the city, including its officers and employees, upon the accuracy of the
information supplied o
the citycias a part this plication. l
SIGNATURE: ., I "41 I DATE I ; - S . I 1
PRINT NAME: T1i D 14/04 . .0....c.-kg Pv`J
33325 8'"Avenue South•Federal Way♦WA♦98003-6325♦253-835-2607•fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160—January 1,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application
Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 11 -104942-00-EL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: THOMAS E JACKA DDS
Project Address: 700 S 320TH ST Suite E Parcel Number: 082104 9265
Project Description: Adding/altering(3)circuits for new washer/dryer and x-ray head relocation
Owner Applicant Contractor
CAPITOL SQUARE LLC WALTHERS ELECTRIC WALTHERS ELECTRIC
PO BOX 18194 13023 PIONEER WAY S WALTHE*154BA(10/30/13)
SEATTLE WA 98118-0194 ORTING WA 98360 13023 PIONEER WAY S
ORTING WA 98360
s� : ;ir
Is Use Educational or Institutional? Nom� Service greater than 999 Amps? No
; lectri •cal Y? varA 6 ` � Y :m'c � a
Circuits-Commercial 3
PERMIT EXPIRES Thursday, December 13, 2012
Permit Issued on Wednesday, December 14, 2011
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
an the/
the i of Federal Way.
42-
Owner or agent: �`` ` vim' / Date:
. , THIS CARD IS TO REMAIN ON-SITE r
CITY OF --- Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
lw
PERMIT#: 11-104942-00-EL Address: 700 S 320TH ST Suite E
Project: CAPITOL SQUARE LLC FEDERAL WAY, WA*98dtrkA ,
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.
UFER Ground (4295) 0 Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) '❑ Rough Electrical(4225) Ceiling Cover(4020)
Approved Approved Approved
By v }' Date`a g_,t `By Date By Date
•
El Final-Electrical (4055)
Approved
By Date
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date