09-103159Project Name: MONTE ?04
Project Address: 29811 MILITARY RD S
Project Description: Repair service mast.
Electrical
Permit #: 09- 103159 -00 -EL
Inspection Request Line: (253) 835 -3050
Parcel Number: 660250 0020
Owner
Applicant
City of Federal Way
ROME MONTE
Community Development Services
NICHOLSON ELECTRIC LLC
P.O. Box 9
1228 SW 157TH ST
980
Federal Way, WA 98063 -9718
FILE
Ph: (253) 835 -2607 Fax (253) 835 -2609
1228 SW 157TH ST
Project Name: MONTE ?04
Project Address: 29811 MILITARY RD S
Project Description: Repair service mast.
Electrical
Permit #: 09- 103159 -00 -EL
Inspection Request Line: (253) 835 -3050
Parcel Number: 660250 0020
Owner
Applicant
Contractor
ROME MONTE
NICHOLSON ELECTRIC LLC
NICHOLSON ELECTRIC LLC
29811 MILITARY RD S
1228 SW 157TH ST
NICHOE *96ILC (613/10)
FEDERAL WAY WA 98003
BURIEN WA 98166
1228 SW 157TH ST
BURIEN WA 98166
�.�0"e fik Y ` .�, T r11M Y' �. spy A
y t aK' a l-1 , tip tltiS tl i ; .. s,
r_,a. i.. 7. t3.s. fix'`2.x t eas`.�..
Is Use Educational or Institutional ? .......................No
j
Mast or Meter Repair (Residential/ 1
PERMIT EXPIRES Tuesday, August 17, 2010
Permit Issued an Monday, August 17, 2009
I hereby certify t t the above ' tormatia orrect and that the construction on the above described property and
the occupancy and the use w' be in eor nce with the laws, rules and regulations of the 6ute of Washington
and a City of Federal Way.
Owner or agent: Date:
4
CITY OF 1
Federal Way
PERMIT #:
Owner:
THIS CARD IS TC —FMAIN ON -SITE
Construction h.. ection Record
INSPECTION REQ41TS: (253) 835.3050
09- 103159 -00 -EL Address: 29811 MILITARY RD S
WELLS FARGO BANK NA FEDERAL WAY, WA 98003 -4227
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.
0
LIFER Ground (42 5)
Ditch cover (0 0)
Temporary Power (4275)
lab /Concrete ( 25 )
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
Pool Bonding (4195)
Temporary Power (4275)
Service (4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Rough Electrical (4225)
Feeders /Sub- panels (4045)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
For inspector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
FedmIMY AUG 17 2, PERMIT
O DEVROPASWSERMM dG1
MCATION
ass=. rrAx a0s 'Y OF FE�1
NAME OF PROJECT
(tenant or Homeoumer Name)
ASRESSOR'N T=rmiCEf. e
5 0 - 0v 2c�-
TYPE OF PERMIT I ❑ DEMOLITION ELECTRICAL ❑ ENGINEEERffiG ❑ FIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
OWNER IS ALSO:
APPLICANT
PROJECT CONTACT
r1he individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
Required for projects with
value of $5,000 or more
(RCW 19.2Zo95l
MAILING ADDRESS, CrIT, STATE, ZIP
ROIL 111h/
CONTRACTOR
MAILING ADDRESS. CITY, STATE, ZIP
/xz" -CI-4) /,<-7
WA STATE CONTRACTOR'S LICENSE e
MARLING ADDRESS, C[TY STATE, ZIP
/LZ�c S' Ge�
NAME
MAILING ADDRESS. COT. STATE, ZIP
ALTERNATECONPACT NAME:
MAUMG ADDRESS, CITY, STATE, zap
❑ APPLICANT
4/e
Wo
EEPIRATIOR DATZ
PRIMARY FHONE
1 -
I onto under penalty of perjury that I am the property owner or autiwrised agent of the property owns. Z eerclfld that to the
bat of my knowledge, the information submittal in support of this permit application is true and correct. I certify that I will comply
with all applicable o t Way regulations pertaining to the work authorised by the issuance of a permiR I understand that
the issuance of permit not remove the oumsr's responsibiNty for comphanee with local, state, or federal twos regulating
construction or environmental
I further agree to hold eJ federal Wog as to any claim /including costs, expenses, and attorneys' Jose incurred
in the investigation and defense such arhtch may be mace by wig person, including the undersigned, and filled against the
City, but olds w such ctahn of ndionce of the city, including its offloars and employees, upon the accuracy qr the
information saw a of oG app n '
SIGNATURE: DATE � V/
PRINT NAME - 4 VA/
Bulletin N 100 — 4/17/2009 Page 1 of 4 k:U-1andoutsTelnlit Application
PRIMARY PRONE
606pg
EMAIL
0
PROJECT CONTACT
c
PRIBLAZY 1,110111M
y
PAX
PRDERAL VINT 31111101111811 IICSIPoE e
fJb!_
PRIMARY PRONE
l -MI:z- 6d&*r -
c
PAX
) -
PRIMARY PRONE
PAX
EMAIL
OWNERrFMMCED
(
PRIMARY PRONE
1 _
I onto under penalty of perjury that I am the property owner or autiwrised agent of the property owns. Z eerclfld that to the
bat of my knowledge, the information submittal in support of this permit application is true and correct. I certify that I will comply
with all applicable o t Way regulations pertaining to the work authorised by the issuance of a permiR I understand that
the issuance of permit not remove the oumsr's responsibiNty for comphanee with local, state, or federal twos regulating
construction or environmental
I further agree to hold eJ federal Wog as to any claim /including costs, expenses, and attorneys' Jose incurred
in the investigation and defense such arhtch may be mace by wig person, including the undersigned, and filled against the
City, but olds w such ctahn of ndionce of the city, including its offloars and employees, upon the accuracy qr the
information saw a of oG app n '
SIGNATURE: DATE � V/
PRINT NAME - 4 VA/
Bulletin N 100 — 4/17/2009 Page 1 of 4 k:U-1andoutsTelnlit Application
Value of Mechanical Work $ -- M COPY OF BID OR ESTIMATE MUST BE PROVIDED ) �
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existingjDaures to remain
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (cm=.i4
BOILERS FURNACES HOT WATER TANKS (c.4
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
•
Bulletin #100 — 4/17/2009 Page 2 of 4 k:\Handouts\Pennit Application
PROJECT VALUATION
ii Pial A I i
SZWER PURVEYOR
VALUE OF EaSTINa IMPROVEMENTS
Indicate number of each type offixture to be installed or relocated as part of this project, Do not include =;
futures toremat . n.
BATHTUBS (wTub/sbc..b.) -
LAVS IH=d Sh&O
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS —
SINKS (ma /uwky)
WATER HEATERS (E1.tdLj
HOSE BIBBS
SUMPS
WASHING MACHINES
•
Bulletin #100 — 4/17/2009 Page 2 of 4 k:\Handouts\Pennit Application
PROJECT VALUATION
WATER PURVEYOR
SZWER PURVEYOR
VALUE OF EaSTINa IMPROVEMENTS
Knamo/pRZVIOUS USX
LOT S= Pn Sqo rs Fee"
RMSTING, FIRE SPRINKLAR SYSTEM?
PROPOSED I= SUPPRESSION SYSTRIS?
❑ Yes ❑ No
❑ Yes ❑ No
•
Bulletin #100 — 4/17/2009 Page 2 of 4 k:\Handouts\Pennit Application