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17-100261 t Electrical of Federal Permit #:17-100261-00-EL Community Development 33325 8th Ave S Federal Way,WA 98003 Inspection Request Line: (253)835-3050 Ph:(253)835-2607 Fax:(253)835-2609 Project Name: CVS PHARMACY Project Address: 33520 21ST AVE SW Parcel Number: 132103 9098 Project Description: Install low voltage wiring for vehicle detection system for drive-up pharmacy window of new retail store Owner Applicant Contractor WASHINGTON CVS PHARMACY LLC DIEBOLD INC DIEBOLD INC 100 WEST MINISTER ST SUITE 1500 936 INDUSTRY DR BLDG 24 DIEBOI*17915(8/1/18) PROVIDENCE RI 02903 TUKWILA WA 98188 936 INDUSTRY DR BLDG 24 TUKWILA WA 98188 Additional Permit information Is this an Online or O.T.C.application Yes �(( • ✓ /i It wr 2 � 4 G Low Voltage-Other(Commei 1 PERMIT EXPIRES Thursday,18 January,2018 Permit Issued on Wednesday,January 18,2017 I hereby certify that the above information is cor d that the construction on the above described property and the occupancy and the a will be in ccorda e with the laws, rules and regulations of the State of Washingt n and e City of Federal Way. Owner or agent: C^�✓y� /?�• Date: / —I 2-o i 7 n � THIS CARD IS TO REMAIN ON-SITE Federal Wa Construction Inspection Record INSPECTION REQUESTS:(253)835-3050 PERMIT#: 17 100261 00 Address: 33520 21ST AVE SW Project: WASHINGTON CVS PHARMACY L FEDERAL WAY WA 98023-2874 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 i Y Y I� Pe qu g g mspectt ogg o this card. o UFER Ground(4295) © Ditch cover(4030) El Slab/Concrete Floor(4255) Approved Approved Approved to place concrete By Date ^By Date ' By Date El Pool Bonding(4195) El Temporary Power(4275) 0 Service(4235) Approved Approved Approved By Date By Date By Date • El Feeders/Sub-panels(4045) 1 8 Rough Electrical(4225) P El Ceiling Cover(4020) Approved Approved Approved By Date I By Date By Date • 10 Final-Electrical(4055) Approved BY O.A.W Date 1 `- a t,— i n 0 Rough Electrical 0 Final Electrical El Right of Way Approved Approved Approved By Date By Date By Date • CITY F ` RESUBMITTED ELECTRICAL Federal Way JAN 18 2017 PERMIT APPLICATION CITY Nr FEDERAL pW�AY I 10 0 2 ( I _ O O CC�AMUNfTY DEVE(_Q�lo' IT NUMBER SUITE/UNIT/SPACE# SITE ADDRESS: 335 #f' / x kJ PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE tle $ /li��t • L3 _ c0 9, s PROJECT NAME / (Tenant or Homeowner Last Name) C 5 ,/ " PROJECT DESCRIPTION P4-Al c-/i«v-, S7f--fe-st-i-+ / /9A.4,--d i c Detailed description of work to W/N�Oy�j. // be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER ( ) - MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ( ) NAME PRIMARY PHONE P/e4 9`Y ( ) — MAILING ADDRESS / Lif (/ E-MAIL ELECTRICAL 7/4 ..Z s yam/✓y A✓ I CONTRACTOR CITY /STATE ZIP FAX �t wit.N... AA-. Mrer ( ) - WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# Dieb o j -Pi` /7,.3"-s-- NAME �...... PRIMARY PHONE APPLICANT pot,v,..4 �'S,0 (Z4�l') .-p- -�"�Z"'/ MAILING ADDRESS E-MAIL 914 AtIte,4 // pr if�C z y ofav%i try .0 ce6049• , CITY / STATE ZIP FAX 7wi .d.C.., w14- 9'/i ( ) - NAME PRIMARY PHONE PROJECT CONTACT " � i/ ,� �/4N'x (yZ-;.SO O- / 3---/ 9 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), • ay be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of relia e of the city, including its officers and employees, upon the accuracy of the information supplied to the ci• as a part f this ap ication. / . SIGNATURE: A _ �_r.�./' [ DATE / ' /O '"- �( ) PRINT NAME: , $o Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application