13-102721 ....iii.,,,,,4'40,...,,....... . RECEIVED ELECTRICAL
CITY OF ``
Federal Way JUN 19 2013 PERMIT APPLICATION
CITY OF FEDERAL WAY•
PERMIT NUMBER /3- / c C/c7Z / - 60
p SUITE/UNIT/SPACE i
SITE ADDRESS: 33 7 S '/'/V��
PROJECT VALUATION ASSESSOR'S TAX/PARCEL I CURRENT/PROPOSED USE
$ e' 3 0 (' 60- 001G
PROJECT NAME
d nteleA
(Tenant or Homeowner Last Name) .40
PROJECT DESCRIPTION Rr/i/ '*---®4.,,,(-- •-- „..,----17.-1,'
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Detailed description of work to .....-----1-70„d..40 v4"/ 102c6! �4 - C K/44 1
be included on this permit only
NAMEPRIMARY PHONE
PROPERTY OWNER �e P✓ ( ) -
MAILING ADDRESS / E-MAIL
CITY STATE ZIP FAX
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NAME _. __
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MAILING r
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CONTRACTOR C STATE ZIP FAX
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WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE I
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APPLICANT .. ' ""'r 12a)3'9/-®3/6
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TATE ZIP FAX
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141/:. , PRIMARY PHONE
PROJECT CONTACT / S d/C/"Zs, ).,97- 5--Z-5
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: - - DATE ��
PRINT NAME: � P4✓ Q��l/;t t
Bulletin#160-January 1,2013 Page 1 of 2 k: -landouts\Electrical Permit Application
, I #
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253)' 835-2807 Fax: (253) 835-2809
* Electrical
Permit #: 13 -102721 -00 -EL
Inspection Request Line: (253)835-3050
Project Name: FRED MEYER
Project Address: 33702 21ST AVE SW Parcel Number: 930100 0010
Project Description: Pull co -aa for mini public view monitor with 24-v cable.
Owner
ARRIlcant
Contractor
FRED MEYER INC
APPLIED TECHNICAL SYSTEMS INC
APPLIED TECHNICAL SYSTEMS INC
PO BOX 42121
7015 SW MCEWEN RD
APPLITS066KD (5/4/14)
PORTLAND OR 97242
LAKE OSWEGO OR 97035
7015 SW MCEWEN RD
LAKE OSWEGO OR 97035
Additional Permit Information
PERMIT EXPIRES Monday,
Permit Issued on
I hereby certify that the above information is
the occupancy and the use will be in accor(
Owner or agent:
"N
prRber 16, 2013
une 19,1013
/tF he co n the above described property and
laws, ru regulations of the State of Washington
of Fed y.
Date: ,�
CITY OF ,
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
13 -102721 -00 -EL Address: 33702 21ST AVE SW
Project: FRED MEYER INC FEDERAL WAY, WA 98023-7762
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.
Final - Electrical (4055)
Approved
By Date
UFER Ground (4295)Ditch11
cover (4030)
Temporary Power (4275)11
Slab/Concrete Floor (4255)
1:1
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
0
Temporary Power (4275)11
1:1
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
0
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
0
Final Electrical
Approved
1:1
Right of Way
Approved
By
Date
By
Date
By
Date