15-102232 is, • 0 Electrical
City of Federal Wa
Community&Econ.Dev.Services Permit #: 15-102232-00-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: FEDERAL WAY CHEVRON
Project Address: 31202 PACIFIC HWY S Parcel Number: 092104 9164
Project Description: Remove and replace(4)fuel dispensers
Owner Applicant Contractor
CHEVRON TEXACO TRI-M ELECTRIC LLC TRI-M ELECTRIC LLC
P O BOX 1392 3509 NE 187TH CT TRIMEL*981PS(10/10/16)
BAKERSFIELD CA LAKE FOREST PARK WA 98155 3509 NE 187TH CT
93302 LAKE FOREST PARK WA 98155
Additional Permit Information
Is Use Educational or Institutional9 No Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial 4
PERMIT EXPIRES Saturday, November 7, 2015
Permit Issued on Monday, May 11, 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: %f - Date:
• THIS CARD IS TO MAIN ON-SITE
CITY OF ',
Construction Inspection Record
=Y�,a�\� ..>.,..-T
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 15-102232-00-EL Address: 31202 PACIFIC HWY S
Project: CHEVRON TEXACO FEDERAL WAY, WA 98003-5402
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) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
. . . . .
o Pool Bonding (4195) El Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
'0 Feeders/Sub-panels(4045) El Rough Electrical(4225) ID Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
Final-Electrical(4055)
Approved
By l 5 Date <-- 1 Zr/ s
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
1 I
•
E ECTRICAL
CITY OF
Federal Way PERMIT APPLICATION
PERMIT NUMBER I - 1 0 Z2 32 00
_ MAY 1 12015
CITY OF FEDERAL WAY
fn..
SUITE/UNIT/SPACE#
SITE ADDRESS: z' ? G 14sj' Sc). e 5-oo
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
_ (04
PROJECT NAME � jc J /'b� 6 /
(Tenant or Homeowner Last Name) ! lYv
ROI/WC/C. ilW,) kEPLIK e.79
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
-772,1 - N? lc- (466 ) 7-T3 -/K29_
MAILING ADDRESS EMAIL
ELECTRICAL (� c oc€iL�"-
-M
CONTRACTOR CITY STATE ZIP FAX
?T /Z.k 9 7ss ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
•'fk t 1 ` . 6137'r -5
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
( )
NAME - PRIMARY PHONE
PROJECT CONTACT )/Irmo e / ( )
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 Iocal, 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: • fl?IL4i- DATE 5-II
PRINT NAME: M I �tbws iT?J
Bulletin#160—January 1,2013 Page 1 of 2 k:AHandouts\Electrical Permit Application