12-1017623
City 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: DENNIS J HAHN, DDS INC PS
Project Address: 1500 S DASH POINT RD
Project Description: Low voltage voice & data cabling.
10 Electrical
Permit #: 12`101762 -00 -EL
Inspection Request Line: (253) 835 -3050
Parcel Number: 052104 9027
Owner
AU12111can
Contractor
DENNIS J HAHN
P W R CONSULTANTS & CONTRACTING
P W R CONSULTANTS & CONTRACTING
1500 S DASH POINT RD
6910 ROOSEVELT WAY NE PMB 202
PWRCOCI997QF (11/7/13)
FEDERAL WAY, WA 98023
SEATTLE WA 98115
6910 ROOSEVELT WAY NE PMB 202
SEATTLE WA 98115
Additional Permit Information,
Is Use Educational or Institutional ? ....................... No
Electrical Fixtures
Low Voltage - Other (Commercial 1
Service greater than 999 Amps? .............................No
PERMIT EXPIRES Wednesday, October 17, 2012
Permit Issued on Friday, April 20, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the usp will a in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: 7--
o►aum i'XIF/*
CITY OF 4 A
Federal Way `}
PERMIT #: 12- 101762 -00 -EL
Project: DENNIS J HAHN
THIS CARD IS TO MAIN ON -SITE
Construction In ection Record -
INSPECTION REQUE TS: (253) 835 -3050
Address: 1500 S DASH POINT RD
FEDERAL WAY, WA 98003 -3753
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.
- Electrical (4055)
Approved
Y Date ?,
UFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)
Slab /Concrete Floor (4255)
Service (4235)
Approved
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
- Electrical (4055)
Approved
Y Date ?,
Pool Bonding (4195)
Temporary Power (4275)
Service (4235)
Right of Way
Approved
Approved
Date
Approved
Date
Approved
By
Date
By
Date
By
Date
0
0
Feeders /Sub - panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved)
Approved
By
Date
By
Date
- Electrical (4055)
Approved
Y Date ?,
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
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 offlcers and employees, upon the accuracy of the
information supplied to the city V b part of this application.
SIGNATURE:
PRINT NAME:
33325 8" 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
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permits may be obtained on -line at www.cityo ederalway.com
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SITE ADDRESS:
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ASS`EESSOWS TAX/PARCEL #
CURRENT /PROPOSED USE
PROJECT NAME
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(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
filz'si-
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS '"
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CITY
STATE
ZIP
FAX
NAME
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WA STATE CONTRACTOR'S LICENSE X EXPIRATION DATE
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NAME
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APPLICANT
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MAILING ADDRESS
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STATE
ZIP
FAX
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PRIMARY PHONE
(10 �) 8l x - 0S
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 offlcers and employees, upon the accuracy of the
information supplied to the city V b part of this application.
SIGNATURE:
PRINT NAME:
33325 8" 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
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