HomeMy WebLinkAbout15-105973City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: BJORKLUND
Project Address: 30426 8TH AVE S
FILE
a. .
Electrical
Permit #: 15-105973-00=gt
Inspection Request Line: (253) 835-3050
Project Description: ALT - Extend same electrical circuits/outlets to new garage.
Parcel Number: 091800 0016
Owner
li n
Contractor
RANDY B BJORKLUND
RANDY B BJORKLUND
OWNER IS CONTRACTOR
30426 8TH AVE S
30426 8TH AVE S
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional Permit Information
Electrical Work Valuation?....................................1500 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No
Electrical Fixtures
Circuits - Residential ...................... 1
PERMIT EXPIRES Sunday, May 22, 2016
Permit Issued on Tuesday, November 24, 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: Date: j ( Z
clry'.4Ai�"
Feral Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE r
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -105973 -00 -EL Address: 30426 8TH AVE S
RANDY B BJORKLUND FEDERAL WAY, WA 98003-4113
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.
Pool Bonding (4195)
UFER Ground (4295)Ditch
cover (4030)
Final Electrical
Approved
lab/Concrete Floor (4 55)
Service (4235)
Approved
By
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
Rough Electrical
Approved1:1
Temporary Power (4275)1:1
Final Electrical
Approved
Service (4235)
Approved
By
Date
Approved
By
Date
Approved
By Date
Date
By
Date
By
Date
❑
Feeders/Sub-panels (4045)
Rough Electrical (4225)El
Ceiling Cover (4020)
Approved
Approved
Approved
By Date
By
Date
By
Date
Final - Electrical (4055)
Pln Approved
1'i
By Ctk) Date
Rough Electrical
Approved1:1
Final Electrical
Approved
o
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF A
Federal Way
RECEIVED
NoV 24 2015
C[Ty OF FEDERAL WAY
CDS
PERMIT NUMBER S _ ( O _ n
ELECTRICAL
PERMIT APPLICATION
/� _
SITE ADDRESS: )/ (.rZ6 (� <`I � s
SUITE/UNIT/SPACE #
PROJECT VALUATION
$ ( 5 00
ASSESSOR'S TAR/PARCEL #
-
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
O T I
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
e-le,&fe 1 C �/'C l� U �Q
Me � � � � (� �
PROPERTY OWNER
NAME n
RGA t�td� ()y 0 14 vj
S3) 3PRIM/ AA -RY PHONE
MAILING ADDRESSE-MAIL
�0qZ6
►�aa(C�uwl�iS�.►1�-f-
CITY
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME J
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
( )
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
// FAX
1 )
PROJECT CONTACT
NAME -
S lv
PRIMARY 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 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 apart of this application.
SIGNATURE:
PRINT NAME: K U ✓-d L{ t ,i U /'
I1A qG
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
