15-103573City 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: SIBORG
Project Address: 806 S 295TH PL
LE
Project Description: Adding/altering (2) circuits for A/C and receptacle
0
Electrical
Permit #: 15- 103573 -00 -EL
Inspection Request Line: (253) 835 -3050
Parcel Number: 515210 0060
Owner
JIM SIBURG
Aoolicant
DAVID V. LONGHURST, PRESIDENT
Contractor
WATTS ELECTRIC SERVICE INC
JEANNETTE SIBURG
WATTS ELECTRIC SERVICE INC
WATTSES1760K (12/9/15)
806 S 295TH PL
PO BOX 46410
PO BOX 46410
FEDERAL WAY WA 98003 -3703
SEATTLE WA 98106
SEATTLE WA 98106
Additional Permit Information
Is this an Online or O.T.C. application ? .................Yes
Electrical Fixtures
Circuits - Residential ...................... 2
Is Use Educational or Institutional ? .......................No
PERMIT EXPIRES Sunday, January 17, 2016
Permit Issued on Tuesday, July 21, 2015
I hereby certify tha the above information is correct and that the construction on the above described property and
the occupancy and he use wil be i acco with the laws, rules and regulations of the State of Washington
_ an the City of Federal Way.
Owner or agent. a._ F Date: 7
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CITY OF
Federal Way
• THIS CARD IS T MAIN ON -SITE
Construction I ection Record
INSPECTION REQUE TS: (253) 835 -3050
PERMIT #: 15- 103573 -00 -EL Address: 806 S 295TH PL
Project: JIM SIBURG FEDERAL WAY, WA 98003 -3703
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.
❑
UFER Ground (4295)
Ditch cover (4030)
Final Electrical
Slab /Concrete Floor (4255)
Approved
Service (4235)
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
n
Final Electrical
Temporary Power (4275)
Service (4235)
Approved
Approved
Approved
Approved
Approved
By
Date
By
By
Date
By
By
Date
E]
Feeders /Sub - panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
E]
Final - Electrical (4055)
Approved
By
Date
Rough Electrical
Approved
n
Final Electrical
Right of Way
Approved
Approved
By
Date
By
Date
By
Date
CITY OF V&
Federal Way
ELECTRICAL
PERMIT APPLICATION
PERMIT NUMBER 15 _ I V :5 5 ! 3 _ F (/
SITE ADDRESS: �V / _
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SUITE /UNIT /SPACE #
PROJECT VALUATION
ASSESSOR'S TAX /PARCEL #
CURRENT /PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
o
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
NAME
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PRIMARY PHONE
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MAILING ADDRESS C
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STATE
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FAX
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ELECTRICAL
CONTRACTOR
NAME
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PRIMARY PHONE
( a6) %67 ,V )I
MAILING ADDRESS
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E-MAIL
CITY
STATE
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FAX
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WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
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FEDERAL WAY BUSINESS LICENSE #
APPLICANT
N
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
(
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FAX
PROJECT CONTACT
N
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 supp to the city as apart of this a is tion.
SIGNATURE: DATE
PRINT NAME:
Bulletin #160 —January 1, 2013 Page 1 of 2 Ul-landoutsTlectrical Permit Application