15-103811 fi. Electrical
City of Federal
Community&Econ.D v.Services7 PLEermit #: 15-103811-00-EL
33325 8th Ave S -
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: BERGLUND
Project Address: 30057 10TH AVE SW Parcel Number: 515320 0416
Project Description: Install(3)outlets,and(6)lights on 2 switches from existing outside 20 amp.
•
Owner Applicant Contractor
LISA BERGLUND NIKOLAY GORBUN SUPREME ELECTRIC
30057 10TH AVE SW SUPREME ELECTRIC SUPREEL946O6(9/26/16)
FEDERAL WAY WA 2304 FIR CT PO BOX 786
MILTON WA 98354 MILTON WA 98354
•
Additional Permit Information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 2
PERMIT EXPIRES Wednesday, January 27, 2016
Permit Issued on Friday,July 31, 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
-•. -- City of Federal Way.
Owner or agent: �f_► Date: ?/S1/1�✓
• THIS CARD IS TO RE ON-SITE
CITYConstruction Insp ion Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-103811-00-EL Address: 30057 10TH AVE SW
Project: LISA BERGLUND FEDERAL WAY, WA 98023-8207
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.
O UFER Ground (4295) `❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date . 'BSS Date 6_� e By Date
' '
o Pool Bonding(4195) El Temporary Power(4275) CI Service(4235)
Approved Approved Approved
By Date By Date By Date
,El Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date
..1. --------GDate g_ ��— By Date
❑ Final-Electrical(4055)
Approved
By C...,\ir. 1\ Date tziti ____t_. ,
❑ Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF RECEIVED ELEC'T'RICAL
Federal Way JUL 312015 PERMIT APPLICATION
\
CITY
�OF/F�EDERAL,WAY
PERMIT NUMBER 5 _ j Q �1 �(D1 1 - E
v ��� SUITE/UNIT/SPACE#
SITE ADDRESS: 3 0D�� 1 0-1-144 v S�iVt G, J/
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# ^ _ rCURRENT/PROPOSED USE
$ 00 0 I -5 5 _ C (1 f
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION 3 UU t�- R'r►d (, Q���S. cM v a S w
Detailed description of work to t t,i*6-k f'l tD
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER • L I S 1 fir /k�
MAILING ADDRESS ) E-MAIL
IG cCITY STATE ZIP FAX
NAME PRIMARY PHONE
5�//�j 0, E c{ c 41-C (Lc;) ;3 z - 8349
MAILING ADDRESS it,
E-MAIL
ELECTRICAL i
CONTRACTOR CITY ST ZIPFAx
vZ'G/&M w 3 ( ) -
0221 WA STATE
" LICENSE / 9 EXPIRATION DATEFEDERAL WAY BUSINESS LICENSE#
NAME 99G///�6 04, /24. /A,
PRIMARY PHONE
APPLICANT (ZS3)32 13q?
MAILINADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT _ $. 4
(Zs3)Sb9' -LS�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), 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 ci lrfarerCpplication.
SIGNATURE: DATE 1/3//
PRINT NAME: /WAd�G�
,�/ ( o,e
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application