14-103979f� y
1
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
• Electrical
Permit #: 14- 103979 -00 -EL
Inspection Request Line: (253) 835 -3050.
Project Name: SIBURG
Project Address: 806 S 295TH PL Parcel Number: 515210 0060
Project Description: Adding/altering (5) circuits for bath remodel, can lights in kitchen in bathroom
Owner
JIM SIBURG
Annlcant
LUCKY ELECTRIC
Contractor
LUCKY ELECTRIC
806 S 295TH PL
2914 136TH ST CT E
LUCKYE *016RF (1/25/16)
FEDERAL WAY WA 98003
TACOMA WA 98446
2914 136TH ST CT E
TACOMA WA 98446
Is this an Online or O.T.C. application ? .................Yes Is Use Educational or Institutional? ....................... No
Circuits - Residential ...................... 5
PERMIT EXPIRES Monday, February 2, 2015
Permit Issued on Wednesday, August 6, 2014
I hereby certify that the ab ve ' ormation is c nd t nstruction on the above described property and
the occupancy and the ill ac n wi t e I s les and regulations of the State of Washington
the ity of ral Way.
Owner or agent: Date:
ii t IN, 3 —) ts to - s.
CITY OF
Federal Way
THIS CARD IS TO MAIN ON -SITE
Construction I ection Record
INSPECTION REQU TS: (253) 835 -3050
PERMIT #: 14- 103979 -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
Approved
Slab/ concrete Floor (4255)
Service (4235)
Approved
Approved
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
E] Temporary Power (4275)
Final Electrical
Approved
Service (4235)
Right of Way
Approved
Approved
Date
Approved
By
Date
Approved
By
Date
By Date
By
Date
Rough Electrical (4225)
Feeders /Sub - panels (4045)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
Date
By
Date
Final - Electrical (4055)
Approved
By
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
0 EL &CTRICAL
CITY OF
Federal Way PERMIT APPLICATION
a
PERMIT NUMBER _ O ��` 00 AUG 0 6 2014
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 defqpse of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such c i a s out of th eli of the cz zn ing its officers and employees, upon the accuracy of the
information supplied t t e pt a p�t o hi �v[ic 'on. j/�
SIGNATURE:
PRINT NAME:
Bulletin # 160 — January 1, 2013 Page 1 of 2 k: flandoutsUectrical Permit Application
SITE ADDRESS:
0�
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CDS
PROJECT VALUATION ---- -_
P /% 00
AS�SOW�S TA- C U 4 -
O _
O
CURRENT /PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
C
✓
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
ICJ'
NAME
PRIMARY PHONE
PROPERTY OWNER
( ) -
MAILING ADDRESS
E -MAIL
CITY
STATE
ZIP
FAX
( )
NAME/
PRIMARY PHONE
-
ELECTRICAL
MAILING ADDRESS
l
``
1/36 - ;— C, —
E-MAIL
CITY
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACT R'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
r`
( )
MAILING ADDRESS
E -MAIL
CITY -
STATE
I ZIP
FAX
( )
PROJECT CONTACT
N
AIC
PRIMARY PHONE
.51) _ Q
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 defqpse of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such c i a s out of th eli of the cz zn ing its officers and employees, upon the accuracy of the
information supplied t t e pt a p�t o hi �v[ic 'on. j/�
SIGNATURE:
PRINT NAME:
Bulletin # 160 — January 1, 2013 Page 1 of 2 k: flandoutsUectrical Permit Application