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Federal Way PERMIT APPL �T��1VE9 N
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CITY OF FEDERAL WAy
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PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME
(Tenant or Homeowner Last Name) ® i'l 'J)A re"`i de C tv..i ,4,—(
PROJECT DESCRIPTION
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Detailed description of work to
be included on this permit only
NAME f PRIMARY PHONE
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NAME PRIMARY PHONE
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CONTRACTOR CII STATE ZIP 6
FAX
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WA STATE CONTRACTC10 LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME A i PRIMARY PHONE
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PROJECT CONTACT NAM PRIMARY PHONE
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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 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 Iocal, 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.
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SIGNATURE: z ----e-,-------7''.-71( DATE C 3��
PRINT NAME: /7t1-1tk/t}L) A
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
S Electrical
City of FederalWay Permit #: 15-104320-00-E L
Community&Econ.D Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-30550
Project Name: HERITAGE CONDOMINIUMS
Project Address: 117 S 340TH ST Unit G Parcel Number: 325945 0510
Project Description: Change out 100 amp panel:
Owner Applicant Contractor
WALTER R ADAMS M S E ELECTRIC M S E ELECTRIC
117 S 340TH ST#G PO BOX 13327 MSEELE*874L8(7/2/17)
FEDERAL WAY WA DES MOINES WA 98198 PO BOX 13327
98003-6607 DES MOINES WA 98198
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
Alt.Serv./Feeder: 0 to 200 amps(11 1
PERMIT EXPIRES Tuesday, February 23, 2016
Permit Issued on Thursday, August 27, 2015
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: F ILE Date:
V‘I*1
0 THIS CARD IS TO IN ON-SITE
"TM°F Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 15-104320-00-EL Address: 117 S 340TH ST Unit G
Project: WALTER R ADAMS FEDERAL WAY, WA 98003-6614
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) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) 0 Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
O Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
'
O Final-Electrical(4055)
Approved
By WO, Date l 0122 t kg-*
ID Rough ElectricalEl Final Electrical EI Right of Way
Approved Approved Approved
By Date By Date By Date
