15-102917 0 Electrical
CommuC333o&2f 5EFceodne.raDleWv.aSyeicesI
Permit #: 15-102917-00-EL
8th Ave S
Federal Way,
IPh:(253)835-2607 Fax:A(29583°)°:35-2609 Inspection Request Line: (253) 835-3050
Project Name: PACIFIC MEDICAL CENTER
Project Address: 31833 GATEWAY CTR BLVD S Parcel Number: 092104 9137
Project Description: Low voltage nurse call installation
Owner Applicant Contractor
ANS LLC CATCH 22 CATCH 22
PO BOX 1941 520 SE LEWIS ST CATCH2*057QW(1/3/16)
AUBURN WA 98071-1941 ISSAQUAH WA 98027 520 SE LEWIS ST
ISSAQUAH WA 98027
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
Low Voltage-Other(Commercial; 1
PERMIT EXPIRES Sunday, December 13, 2015
Permit Issued on Tuesday, June 16, 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 th11City of Federal Way.
Owner or agent --< -- Date: b 4!` - f '�
t._ .
Vim:
r
c;ry°F �' Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 15-102917-00-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) ❑ Ditch cover(4030) . 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding (4195) .El Temporary Power(4275) �D Service(4235)
Approved Approved Approved
By Date By Date By Date
•
0 Feeders/Sub-panels(4045) .0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
Final-Electrical (4055)
Approved
By Date `1-1:6-‘s
ElRough Electrical1:1 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
.
•
�. ELECTRICAL
CITY OF
Federal Way PERMI :,',.; PLICATION
PERMIT NUMBER 1 5 _ I0 f / _ (V� JUN 16 2015
lJ CITY OF FEDERAL WAY
(�/ DS SUITE/UNIT/SPACE#
SITE ADDRESS: 31 '8 33 �'A-r "w/\ j 13 y r 7
1i'
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
S ( ,J _ -
PROJECT NAME • /�% �/
(Tenant or Homeowner Last Name) D I L r�'i C 'i'1j''� ���p� j�
PROJECT DESCRIPTION Low V GL`�n c jE 1 uizsri` (/7 Cc I)IS( / (049 ((e)/`/
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER1D( �. f- f ) ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
NAME r PRIMARY PHONE
�Uk =( J Dai 6-i rc#2 _ (y2.0�9- J1-i 6
MAILING ADDRESS + /n1 /,^ E- L j
i)
ELECTRICAL J .� ( J�1 s S1 I$ )G j, `) A till !"i= Ko."W/,/
CONTRACTOR CITY STATE ZIP FAX L
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
(i) %C (J 2 4 C'S10bL
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
( )
NAME / PRIMARY PHONE
PROJECT CONTACT R V l f r ( )
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 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: . 44:42
DATE i/6, /6
PRINT NAME:
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application