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15-105400
Electric-31 City of Federal Way Community&Econ.Dev.Services Permit #: 15-105400-00-EL 33325 8th Ave S Federal way,WA 98003 Inspection Request line: (253)835-3050 Ph:(253)835-2607 Fax:(253)835-2609 Q Project Name: H&R BLOCK Project Address: 1612 SW DASH POINT RD Parcel Number: 189880 0010 Project Description: Install data&phone cable Owner Applicant Contractor AUDREY/SYDNEY IRMAS CHARITABLE VIRGIL KNEDLIK OWNER IS CONTRACTOR FOUNDATION KNEDLIK FAMILY LLC (H&R BLOCK) 20206 72ND AVE S 1649A SW DASH POINT RD KENT WA FEDERAL WAY WA 98023 98032-2322 Additional Permit Information Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No Service greater than 999 Amps9 No Electrical Fixtures Low Voltage-Other(Commercial 1 PERMIT EXPIRES Tuesday, April 19, 2016 Permit Issued on Thursday, October 22, 2015 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: A . Date: / )-)-/ 1 juo 0 THIS CARD IS TO RE p IN ON-SITE , Construction Ins ion Record '� CITY of Federal Way INSPECTION REQUESTS: (253) 835-3050 PERMIT#: 15-105400-00-EL Address: 1612 SW DASH POINT RD Project: AUDREY/SYDNEY IRMAS CHARIT) FEDERAL WAY, WA 98023 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. ID UFER Ground(4295) El Ditch cover(4030) " -El Slab/Concrete Floor(4255) - Approved Approved Approved to place concrete By Date By Date By Date Pool Bonding(4195) : ❑ Temporary Power(4275) ❑ Service(4235) Approved Approved Approved By Date By Date By Date (0 Feeders/Sub-panels •(4045) • Rough Electrical(4225) * E Ceiling Cover(4020) Approved Approved Approved By Date By Date By Date t ti - as-is Final-Electrical(4055) Approved By Date • i" Rough Electrical ❑ Final Electrical ❑ Right of Way L-- Approved Approved 123Y Date By Date By Date s. • RECEIVED CITY OF AIL OCT 212015 ELECTRICAL Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION CDS PERMIT NUMBER I 5 _ I b J q 0 0 _ i L/ 1 SUITE/UNIT/SPACE# SITE ADDRESS: / / 01 p PROJECT VALUATION ASSESSOR'S TA�/PAI�L# � � - © Q � O CURRENT/PROPOSED USE PROJECT NAME d� ,[� (Tenant or Homeowner Last Name) 1 n)L�1�1 i K f 'i CY i-(�c d j/A W`p,1? zi-riL/L PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAM PRIMARY PHONE PROPERTY OWNER 1 . : - l.y L - A ' --+- - ,w,c• MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ( ) - NAME PRIMARY PHONE n(A et °Pir (0.24 ),2D -d'2-3 7 MAILING ADDRESS E-MAIL ..64 s.191 — ti ELECTRICAL /,(,/r� S,+J � /N 1 _ CONTRACTOR CITY STATE ZIP .()1 FAX /=C,,D LYL14- c�r4 r �if 5eo a.3 (9t ) - hi ; WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / NAME PRIMARY 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 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 arcs- out of the reliance of the city, including its officers and employees, upon the accuracy of the information suppl'-d/11- ity . a part of this application. SIGNATURE: DATE /J/1/r PRINT N iii, 1 J�.lj 1 L (. p✓L0%-/ic_ r Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application