12-102787 44%., - °
CITY OF
Federal Way ELECTRICAL RECEIVED
PERMIT APPLICATION JUN 19 2012
CITY OF FEDERAL WAY
**Most electrical permits may be obtained on-line at www.cityo ederalway.com*CDS
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SITE ADDRESS: 3
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SUITE/UNIT/SPACE# ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAMHA
(Tenant or Homeowner Last Name) ( 1�/
PROJECT DESCRIPTION /&/"Fed l/7 j2/Z'4
Detailed description of work to , ,}
be included on this permit only A2/72,-)7 U
NAME PRIMARY PHONE
PROPERTY OWNER ->'it> ( ) -
MAILING ADDRESS E-MAIL
CITY , STATE ZIP FAX
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NAME PRIMARY PHONE
AZ/917e„/ 4/ ( ) -
MAILING ADDRESS { E-MAIL
ELECTRICAL .A72,-/C3j L% _j (/' , /r
CONTRACTORCIT ' STATE ZIP FAX
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WA STATE CONTRACTOR'S LICENSE EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME 1,4,a ,&74PRIMARY PHONE
APPLICANT ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT ( )
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
a
the investigation and defense of such claim), which may be made byany 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.
SIGNATURE_ i/ -� DATE �6T zf.
PRINT NAME: 77-1;9;7(p /LL S( �
33325 8'h 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:Wandouts\Electrical Permit Application
s
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
i 0 Electrical
Permit #: 12-102787-00-EL
Inspection Request Line: (253) 835 -3050
Project Name: HAITU
Project Address: 2323 SW DASH POINT RD
Project Description: Remove /replace 0 -200 amp panel
Parcel Number: 122103 9095
Owner
Applican
Contractor
VEACESLAV HAITU
VEACESLAV HAITU
VEACESLAV HAITU
2323 SW DASHPOINT RD
2323 SW DASHPOINT RD
2323 SW DASHPOINT RD
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Is Use Educational or Institutional ? .......................No
Electrical Fixtures
Alt. Serv. /Feeder: 0 to 200 amps (F 1
PERMIT EXPIRES Sunday, December 16, 2012
Permit Issued on Tuesday, June 19, 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: .�`�y Date:
% —V
CITY OF c5.
Federal Way
PERMIT #:
Project:
THIS CARD IS TO MAIN ON -SITE
Construction In ection Record
INSPECTION REQUE TS: (253) 835 -3050
12- 102787 -00 -EL Address: 2323 SW DASH POINT RD
VEACESLAV HAITU FEDERAL WAY, WA 98023 -7815
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.
Final - Electrical (4055)
Approved 2
By fA4 DatefllIy`r 17
❑
LIFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)
Slab /Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved 2
By fA4 DatefllIy`r 17
❑
Pool Bonding (4195)
❑
Temporary Power (4275)
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
❑
E]
Rough Electrical (4225)
Feeders /Sub - panels (4045)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved 2
By fA4 DatefllIy`r 17
❑
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date