13-103571 } t
•
Electrical
City of FedWay .., Permit #: 13-103571-00-EL
Community&Econ.D ev.Services
33325 8th Ave S "--
Federal Way,WA 98003
Inspection Request Line: 253 835-3050
Ph:(253)835-2607 Fax (253)835-2609 p
Project Name: COMFORT DENTAL OF FEDERAL WAY
Project Address: 31401 PACIFIC HWY S Parcel Number: 082104 9216
Project Description: Install(2)0-200 amp service for associated remodel
Owner Applicant Contractor
PAVILIONS CENTRE ASSOCIATES ELECTRIC SYSTEMS LLC ELECTRIC SYSTEMS LLC
120 W DAYTON SUITE D-9 PO BOX 9276 ELECTSL979KE(5/5/15)
EDMONDS WA 98020 TACOMA WA 98490 PO BOX 9276
TACOMA WA 98490
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
Alt.Srvc/Feeder 0 to 200 amps(C 2
PERMIT EXPIRES Monday, February 10, 2014
Permit Issued on Wednesday,August 14, 2013
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: /1
� � �� �-- Date: / 4f 1
FINALED
. ;-DATE INSPECTOR- AREA AND FYPE OF INSPErCTION - .%
P
r THIS CARD IS TO MAIN ON-SITE _ •
CITY OF • Construction In ction Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 13-103571-00-EL Address: 31401 PACIFIC HWY S
Project: PAVILIONS CENTRE ASSOCIATES FEDERAL WAY, WA 98003-5405
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) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By k 6 Date 9 113 I I By Date
El Pool Bonding(4195) El Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
o Feeders/Sub-panels(4045) 0 Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date 111413 Date q- 2s-A./ By Date
.0 Final-Electrical(4055)
Approved
Date j/(7/
�
❑ Rough Electrical El Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
• 4.
• . i
u ELECTRICAL
CITY OF
Federal Way PERMIT APPIRWAITE9N
PERMIT NUMBER ! — 1 0 ( - 0 0 AUG 14 2013
CITY OF FEDERAL WAY
SUITE/UNITE:15 E#
SITE ADDRESS: r-11 PAC 1A21 �+ lI..UU
CIYJA
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 3E 0° fig` l
PROJECT NAME
(Tenant or Homeowner Last Name)
/, j- Vtie rLA✓ Jti c a>4
PROJECT DESCRIPTION am"' ( `.i c(c( -` OF Spite ((v—rv(1 i i\,01
Detailed description of work to IS L) 4-11 i-#11
.i i+ri.( 'i iA �
be included on this permit only -
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP ( FAX
( )
NAME PRIMARY PHONE
aT a .. . (OD-3)`tt, -'
MAILING ADDRESS E-MAIL
ELECTRICAL Pc) RIL>1' '542 'P�.�Q il':c.'cyS 1<_„(.4
CONTRACTOR CITY STATE ZIP +y FAX
o
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
-'St -l914.E i lir 2D.07-!Oa 33--Qa-&
NAME PRIMARY PHONE
-
APPLICANT L YN& 1",(b3
MAILING ADDRESS E-MAIL
4
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Day D (Z{))'t6tkocl
-
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: � DATE g//•//13
3
PRINT NAME: _i' `T 42^ C.3.3 l-v IA-11
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application