14-104971 • • Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 14-104971-00-EL
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p 4
Project Name: PAYLESS SHOESOURCE
Project Address: 1812 S COMMONS Parcel Number: 762240 0010
Project Description: Installation of troffers,emergency lights and relocate trac lighting.
Owner Applicant Contractor
PAYLESS SHOESOURCE FORBES ELECTRICAL CONSTRUCTION CO FORBES ELECTRICAL CONSTRUCTION CO
1812 S COMMONS 1502 S BROOKSIDE TERRACE FORBEEC032O9(10/10/15)
FEDERAL WAY WA 98003 TACOMA WA 98465 1502 S BROOKSIDE TERRACE
TACOMA WA 98465
•
Additional Permit information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial. 6
PERMIT EXPIRES Wednesday, March 25, 2015
Permit Issued on Friday, September 26, 2014
I hereby certify that the above informati n is correct and that the construction on the above described property and
the occupancy and the us ill be in cordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way. �j
Owner or agent Date: -- .2 -"2-12/
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• THIS CARD IS TO IN ON-SITE
■
�moF Construction In ection Record
Federal Way INSPECTION REQ TS: (253)835-3050
PERMIT#: 14-104971-00-EL Address: 1812 S COMMONS
Project: PAYLESS SHOESOURCE FEDERAL WAY, WA 98003
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 (4295) El Ditch cover(4030) - 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
o Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) El Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
By--\--e S Date 1 0 H 4_ k 1
El Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
EL
, Rece,
CI OF
C'TRICAL
Federal Way PERMIT 2 6 Z014 PERMIT APPLICATION
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PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME t
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NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
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NAME PRIMARY PHONE
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MAILING ADDRESS E-MAIL
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CONTRACTOR CITY STATE ZIP FAX
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WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
F02.P£ .00lc 3201 3 /e8 /l s
NAME PRIMARY PHONE
APPLICANT Ra t kAA. L '�O S ( ) -
MAILING ADDRESS E-MAIL.
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PROJECT CONTACT a I 1/! 4 PRIMARY PHONE
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I certify under penalty of perjury that I am the property owner or authorised 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 supplied to the city as part of this application.
SIGNATURE: 1/( DATE q'Z C' I/
PRINT NAME: Ra f p h L 1---;,--6t 5
Bulletin#160—January 1,2013 Page 1 of 2 101-Iandouts\Electrical Permit Application