15-102161 •
4,„ ELtCTRICAL
CITY OF
Federal Way PERMIT APPLICATION
PERMIT NUMBER I Cj _ 1 0 2 ( Co ( _ CO MAY 0 6 2015
CITY OF FED WAY
(�Q SUITE/iJ,�j,� c `#99f i t
SITE ADDRESS: J 1 S3 G/ l,i / �� LID s ( �J
PROJECT VALUATION ASSESSOR'S TAX/PARCEL#� i - � � � � CURRENT/PROPOSED USE
Ccc l// G/l�J
PROJECT NAME f j CAI.--
,
(Tenant or Homeowner Last Name) P�`-tel C 7
;:J/ l 1 L
rAvST, L ( srv��JL e 7.)2.7-0-C7Of -Z-1`171---71.2-1-0
PROJECT DESCRIPTION z //.r`i /1 ( /'At7 T t ,7 4I10 /a'5
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP ( FAX
l )
NAME PRIMARY PHONE
i'4,e, So,~- c.� 11C L-,✓C ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL 9( 2 0 s/0i, ,,.}- Ptc, €- -# 20
CONTRACTOR CITY STATE Z FAX
,- tr&-- WA 1103 ( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
lCiC7.0C=.- /3- CjZ 2 / iz /17 To - /00 7C{7
NAME PRIMARY PHONE
`
APPLICANT JCS.`^ '0// (2C.6) ' '-g,1 - 0a91
MAILING ADDRESS _ E-MAIL
3 rkvw,_ `--J Kr oJiIlso��tI G L
CITY STATE ZIP FAX ].
( ) ___"`111
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 thatI 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 a part of this application.
SIGNATURE: c ! DATE �� "'
PRINT NAME:
Bulletin#160-January 1,2013 Page 1 of 2 k:AHandouts\Electrical Permit Application
Electrical
City of Federal Way Permit #: 15-'102'16'1-00-EL
Community&Econ.D ev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Re uest Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 q
SiFILE
Project Name: PACIFIC MEDICAL CENTER
Project Address: 31833 GATEWAY CTR BLVD S Parcel Number: 092104 9137
Project Description: Adding(1)circuit for(8)interlock smoke detectors at(4)fire doors and(8)door mag hold
open
Owner Applicant Contractor
ANS LLC NELSON ELECTRIC INC NELSON ELECTRIC INC
PO BOX 1941 9620 STONE AVE N SUITE 201 NELSOEI132CZ(2/12/17)
AUBURN WA 98071-1941 SEATTLE.WA 98103 9620 STONE AVE N SUITE 201
SEATTLE WA 98103
•
Additional Permit Information
Is this an Online or O.T.C.application? No Is Use Educational or Institutional? No
Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial 1
PERMIT EXPIRES Monday, November 2, 2015
Permit Issued on Wednesday, May 6, 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
nd the City of Federal Way. � /�
Owner or agent: i- Date: 5 0
DATE INSPECTOR AREA AND "TYPE ( INSPECTION
5115'Iit 1,43 rr Ho(AA/ Ram* ih- 1A4vdIid Gowidors
THIS CARD IS TOMMAIN ON-SITE
CITY OF 1.1.1111114 • Construction Ipection Record -
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-102161-00-EL Address: 31833 GATEWAY CTR BLVD S
Project: ANS LLC FEDERAL WAY, WA 98003-5420 `
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.
El UFER Ground(4295) DI Ditch cover(4030) Ei Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
❑ Feeders/Sub-panels(4045) El Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By 0,..__U Date TA___1 `1 S
0 Final-Electrical(4055)
Approved
By Q.�. Date _�l `1
E Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date