13-104058r
T ire a
___4, Electrical
City of Federal Way ,,a •
1,4 Permit #: 13-104058-00-EL'
Community&Econ.Dev.Services �- t b �
33325 8th Ave S ___'
Federal Way,WA 98003 Li i,Lv,, __ Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 P q
Project Name: KOHL'S AT THE COMMONS
Project Address: 2101 S COMMONS Parcel Number. 762240 0010
Project Description: Install owner provided 800 amp service and lights.Wire all line and low voltage including
fire alarm
Owner Applicant Contractor
KOHL'S DEPARTMENT STORE EVERGREEN ELECTRICAL SYSTEMS EVERGREEN ELECTRICAL SYSTEMS
N56 W17000 RIDGEWOOD DR 1900 W NICKERSON ST SUITE 116-9 EVERGES904CH(2/13/14)
MENOMENEE FALLS WI SEATTLE WA 98119 1900 W NICKERSON ST SUITE 116-9
53051 SEATTLE WA 98119
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
Alt.Srvc/Feeder 601- 1000 amps 1
PERMIT EXPIRES Tuesday, March 11, 2014
Permit Issued on Thursday, September 12, 2013
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
_9427 and the City of Federal Way.
Owner or agent: Date: 7'- /2 - 13
/41
00
DATE INSPECTOR AREA AND TYPE O� INSPECTION
Wet I 1 - j €4,sf€ ) ArJ 3Sr'
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THIS CARD IS TO MAIN ON-SITE I
C;TY OF •
Federal Way Construction In ect>lon Record
y INSPECTION REQUE TS: (253)835-3050
PERMIT#: 13-104058-00-EL Address: 2101 S COMMONS
Project: KOHL'S DEPARTMENT STORE 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.
E UFER Ground(4295) LJ Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date Byes Date to ,1C _t-�
® Pool Bonding(4195) 0 Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By3('S Date[0-- /44,
o Feeders/Sub-panels(4045) '0 Rough Electrical(4225) '0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date B CCU Dateca t e, I 3
Final-Electrical(4055)
E Approved
Date V-- Z
Joe Sc jyiteil CO Ov► 123 ilLt
❑ Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
. • • .. ,
ELECTRICAL
CITY OF
Federal Way PERMIT APPLICATION
� I � � 5-S---- Q� RECEIVED
PERIQT NUMBER 1 - ` -l' -
- -- - -- SEP 122013
SITE ADDRESS: / ) " 801 5 RAL WAY
! �✓ � Z�S C�. a / CDS
PROJECT VALUATION �� AE �TA7[/PARCEL�� � _ O / � CURRENT/PROPOSED USE
2 _I/7S - - (220 —h0/}—
PROJECT N r( / ( �l CG/1/-/ DI V L
(Tenant or Homeowner Last Name) K(?
PROJECT DESCRIPTION Se >^ r i^. a t cL / 9 h -7's / /r i,'e et! lr t/2L�
Detailed description of work to C?f'. 1 (®{aJ UO/117%,7 c'.•e ! 4 c 1 ;J< ,',Y' ' F1.#^e /9 /a.-01
be included on this permit only e' e-
NAME PRIMARY PHONE
PROPERTY OWNER D r-eCt <''- ( ) -
MAIMAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME r r -PRIMARY PRONE
I veYr/r'eivi. 174-r,"'iG�; -, al/ e*L�� 77.3 0//7
RAILING ADDRESS` /
ELECTRICAL I /9 ) I�./!/ eje r Spy' f 5-fe I I6- \j cam_-ecS ro i?tt P Y,cam
CONTRACTOR
CITY STATE ZIP PAZ
.Serc-tf 1444 ?i 7'' j ( ) - .
WA STATE CONTRACTOR'S LICENSE a EXPIRATION DATE FEDERAL WAY NUSIIMESS LICENSE f
F14: 1/26--.S ?D 67 C1/I
NAME PRIMARY PRONE
APPLICANT E ES �4� ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP PAZ
( ) -
NAME J PRIMARY PRONE
PROJECT CONTACT -Jr-v-e- GIs U ri (ylasj 713 0/1-/Z
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
an applicable City of Tederai Way regulations pertaining to the work authorised 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 a part of this application.
1, / )
SIGNATURE: � /1� DATE -/ I r, i
P R I N T NAME: c C 9.e. (a (7/-7-b--;:-6.6-,-
-
Bulletin#160-January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application