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City of Federal Way Permit #: 15-103856-00-E L
Community &Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line: 253 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609 pecq
Project Name: SLAVIC GOSPEL CHURCH
Project Address:. 3405 S 336TH ST Parcel Number: 726120 0105
Project Description: Install lights and switches for new foyer addition
Owner
ARRIIcant
Contractor
SLAVIC GOSPEL CHURCH
YURI MANCHIK
OWNER IS CONTRACTOR
3405 S 336TH ST
SLAVIC GOSPEL CHURCH
FEDERAL WAY WA 98001
33130 SW 42ND PL
FEDERAL WAY WA 98023
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
Circuits - Commercial .................... 5
PERMIT EXPIRES Sunday, January 31, 2016
Permit Issued on Tuesday, August 4, 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
Date: (9.$ — 4 --/ _ WZ_V—
CITY OF Ah�
Federal Way
PERMIT #:
Project:
THIS CARD IS TOMAIN ON-SITE I 4w
Construction In ection Record
INSPECTION REQUE TS: (253) 835-3050
15 -103856 -00 -EL Address: 3405 S 336TH ST
SLAVIC GOSPEL CHURCH FEDERAL WAY, WA 98001-9630
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.
®
LIFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
13
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
❑
Temporary Power (4275)
13
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
E]
E]
Ceiling Cover (4020)
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
V-vDate 8 Ct 1
BSS
Date w � 2 Q ( i
1:1 Final - Electrical (4055)
Approved
By Date
®
Rough Electrical
Approved
EJFinal
Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
PERMIT NUMBER 1 � _ 10 ✓ �3 5_(� _
0
ELEC'T`RICAL
PERMIT APPLICATION
o o RECEIVED
V
AUG 0;4 2015
-- `�.��WAY
SITE ADDRESS: S Q S �` -C.�i
CDS
PROJECTA� C
s
C)ION ASSESSOR'S TAR�ARCE i # � _ O � �
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
/
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
N S ( i ' ^' t> S �v = C.� s e �' �✓
PROPERTY OWNER
NAME
� r 6U ( r 00 C (_ I
PRIMARY PHONE
MAILING ADDRESS
3YO-�_ ,S 33644 Sin. ��
E-MAIL
V E e iF-X d l3 C(p*ifo
CITY -
STATE
I ZIP
FAX
( )
ELECTRICAL
CONTRACTOR
NAME
O c._� Al --e c2
PRIMARY PHONE
( ) -
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
c�rz( VPjgIrlC4--7
PRIMARY PHONE
27s-2SS(2Z
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
( )
PROJECT CONTACT
NAMEPRIMARY
>1l %f4 /V G
PHONE
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.
' �/
PRINT NAME: / Lt C2 f / `✓ f
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
