12-104187City of Federal Way'
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2809
Electrical
Permit #: 12- 104187 -06 -EL
Inspection Request Line: (253) 835 -3050
Project Name: EVERGREEN BIBLE CHAPEL
Project Address: 34030 21ST AVE SW i Parcel Number: 242103 9080
Project Description: Adding/altering (1) circuit for street light install
Owner
AR1211can t
Contractor
EVERGREEN BIBLE CHAPEL
EVERGREEN BIBLE CHAPEL
OWNER IS CONTRACTOR
34030 21ST AVE SW
34030 21ST AVE SW
FEDERAL WAY WA
FEDERAL WAY WA
98023
98023
Additional Permit Information
Is Use Educational or Institutional ? .......................No
Electrical Ficidutos
Circuits - Commercial .................... 1
Service greater than 999 Amps? .............................No
PERMIT EXPIRES Monday, March 11, 2013
Permit Issued on Wednesday, September 12, 2012
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: - Q Y ) L"—JQ Date: g z Z
�- �->n.9 I 0/3 0/rZ
CITY OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO IN ON -SITE
Construction Ins ection Record
INSPECTION REQ TS: (253) 835 -3050
12- 104187 -00 -EL Address: 34030 21 STAVE SW
EVERGREEN BIBLE CHAPEL FEDERAL WAY, WA 98023 -7615
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.
Feeders /Sub - panels (4045) -
Approved
By Date
Final - Electrical (4055)
Approved
By Date Q— 3 rL\.. i
Rough Electrical (4225)
Approved
By Date
Ceiling Cover (4020)
Approved
By Date
UFER Ground (42 )
Ditch cover (4030)
Temporary Power (4275)
Slab /Concrete Floor (4255)
0
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Feeders /Sub - panels (4045) -
Approved
By Date
Final - Electrical (4055)
Approved
By Date Q— 3 rL\.. i
Rough Electrical (4225)
Approved
By Date
Ceiling Cover (4020)
Approved
By Date
Pool Bonding (4195)
Temporary Power (4275)
0
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders /Sub - panels (4045) -
Approved
By Date
Final - Electrical (4055)
Approved
By Date Q— 3 rL\.. i
Rough Electrical (4225)
Approved
By Date
Ceiling Cover (4020)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF -
FecW@tWft ELEC'T'RICAL
SEP 12 2012
PERMIT APPLICATION
CITY OF FEDWGiINb"ectrical permits may be obtained on -line at www.ciryo ederalway.com ** !11 gagill
SITE ADDRESS: V e
/UNIT /SPACEM
ASSESSOR'S T�AR�
�
CURRENT /PROPOSED USE
USUITE
PROJECT NAME
1
(Tenant or Homeowner Last Name)
_ l 10
/ /V 9"7* ` L
ND P0 ,V E k
PROJECT DESCRIPTION
No�t�f? in�G
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
%�'o y %:�`UlU it E` L
PRIMARY PHONE
{-7 3) 7Z.0- 6 !
MAILING ADDRESS
E -MAIL
3.414,36 1A1"-- S' L'4J
�0 ykUAIKE4."01.441
CITY
STATE
ZIP
FAR
9�7- 7 9�'9
NAME
PRIMARY PHONE
( ) -
MAILING ADDRESS
E -MAIL
ELECTRICAL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE W EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
NAME
p o 1 <�NkE L
. PRIMARY PHONE
x5 3) 720 _ So ! G
APPLICANT
MAILING ADDRESS
E -MAIL
CITY j
/C�C/4C "L Way
STATE
Wh
ZIP
9840 2 �3
FAX
(21-3) 927 _ 7944
PROJECT CONTACT
NAME
? d /KV tv K e. L
PRIMARY PHONE
(2 s3) 7Zv - f o 1 Z
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 partt of this application.
SIGNATURE: %�� / C"' J DATE Z
PRINT NAME: / -� b X /'N y AJ J-,—
33325 8h 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
NEW SINGLE FAMILY RESIDENCE
Total Square Feet
(including attached garage):
FEES: First 1300 ft2 - $122.00;
Each additional 500 ftz - $39.00
NEW MULTIFAMILY (3 units or more)
1st Service /Feeder Additional Feeders
ALTERED SINGLE or MULTI FAMILY
1- Service /Feeder
No
e o- a MX
Added or Altered Circuits ..
1 -4 circuits $80.50; each additional $8.00
Mast or meter repair $60.50
MANUFACTURED HOMES
Service or feeder..
NEW COMMERCIAL
1s1 Service /Feeder Additional Feeders
ALTERED COMMERCIAL
1- Service /Feeder Additional Feeders
WAS
3�
Added or Altered Circuits AV1Le�
1 -5 circuits $103.50; each additional $8.00
Mast or meter repair $111.50
PLAN REVIEW FEES
Plan Review required only for:
• New, or alteration to, service of 1,000 amps or greater
• Medical /Educational /Institutional Facility
$103.50 plus 35% of Permit Fee
(Permit Fee x 350% _ + $103.50 = Plan Review Fee)
Plan review for modified submittals $105.50 /hour
MISCELLANEOUS SERVICE /EQUIPMENT
LOW VOLTAGE TEMPORARY SERVICE
❑ Fire Alarm System 1st Service /Feeder Additional Feeders
❑ Security Alarm System
❑ Voice /Data Cabling
❑ Other
Area to be served by system:
I- 2,500 ft2- $71.00; each additional 2,500 fr2 - $18.50
# of Thermostats
First $60.50; each additional $18.50
Yard Pole /meter loops /pedestal x $ 80.50
Portable Generator (transfer equipment) x $101.00
Ditch cover /inspection only x $121.00
QWdWAIN-1 M40*
FEE CALCULATIONS
• Fees are determined by the scope of work as indicated.
• A $6.00 Automation Fee will be added to all permits.
• For assistance in calculating fees or completing the
application form, contact the Permit Center at
253- 835 -2607
33325 e Avenue South ♦ Federal Way ♦ WA ♦ 98003 -6325 ♦ 253- 835 -2607 ♦ fax: 253- 835 -2609 ♦ www.cityoffederalway.com
Bulletin # 160 - January 1, 2011 Page 2 of 2 k:Wandouts\Electrical Permit Application