15-102768 el
__ • Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 15-102768-00-EL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: PACIFIC MEDICAL CENTER
Project Address: 31833 GATEWAY CTR BLVD S Parcel Number: 092104 9137
Project Description: Installation(3)low-voltage thermostats.
Owner Applicant Contractor
ANS LLC MACDONALD MILLER FAC SOL INC MACDONALD MILLER FAC SOL INC
PO BOX 1941 (ELECTRICAL) (ELECTRICAL)
AUBURN WA 98071-1941 7717 DETROIT AVE SW MACDOMF972BF(1/6/17)
SEATTLE WA 98106 7717 DETROIT AVE SW
SEATTLE WA 98106
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
Thermostat 3
PERMIT EXPIRES Saturday, December 5, 2015
Permit Issued on Monday, June 8, 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 the City of Federal Way.
Owner or agent: , ,____k_ L�,��--A--- . Date: 6)/S' / 1S-
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` • THIS CARD IS TO()MAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-102768-00-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.
❑ UFER Ground (4295) "❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
. .
0 Pool Bonding(4195) #❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
.
'0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By ^ C. Date `F t
❑ Final-Electrical(4055)
Approved
By VA4 Date `11'245—
a
P
Rough Electrical Final ElectricalCI
Right of Way
Approved Approved Approved
Date By Date By Date
�► I"�' E
CITY OF .W�'� - 015
JUN o 8 2 C RI CAL
Federal Way CITY OF PERMIT APPLICATION
FEDERAL WAY
CDS
PERMIT NUMBER /S— 1 /472
/
I 3,33 61 61/ 00 6 C/9. SUITE/UNIT/SPACE#
SITE ADDRESS: 2500 S 320TH T 1-EDERAL WAY,WKJ8003
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
900.00 0 9 2 1 0 4 - 9 1 3 7 MEDICAL CLINIC
PROJECT NAME PACIFIC MEDICAL CENTER-CLINIC
(Tenant or Homeowner Last Name)
INSTALL(3) LOW VOLTAGE T-STATS
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER PACIFIC MEDICAL CENTER ( 206 ) 621 - 4466
MAILING ADDRESS E-MAIL
1200 12TH AVE S N/A
CITY SEATTLE STATE ZIP 98144 FAX
WA ( ) _
NAME PRIMARY PHONE
MACDONALD MILLER FAC SOL
( 206 ) 768 - 4278
MAILING ADDRESS E-MAIL
ELECTRICAL 7717 DETROIT AVE SW darla.doll@macmiller.com
CONTRACTOR CITY STATE ZIP FAX
SEATTLE WA 98106 ( 206 ) 768 - 4279
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
MACDOMF972BF 01 / 06 /2017 20-03-10072-00-BL
NAME PRIMARY PHONE
APPLICANT MACDONALD MILLER FAC SOL ( 206 ) 768 -4278
MAILING ADDRESS E-MAIL
7717 DETROIT AVE SW darla.doll@macmiller.com
CITY STATE ZIP FAX
SEATTLE WA 98106 ( 206 ) 768 - 4278
NAME PRIMARY PHONE
PROJECT CONTACT TOM WINGARD (206 ) 240 7340
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: __,,,__---.1A, _ `-`) DATE 06-8-2015
PRINT NAME: DARLA DOLL
r
Bulletin#160—January 1,2013 Page 1 of 2 k:\HandoutsVElectrical Permit Application