14-100096 •
• S Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 14-100096-00-EL
33325 8th Ave S
,
Ph:(253)Federal 835-2607WayFax:WA(295830)08335-260 9 Inspection Request Line: (253) 835-3050
Project Name: VIRGINIA MASON-GENERAL INTERNAL MEDICINE (GIM)
Project Address: 33501 1ST WAY S Parcel Number: 926504 0010
Project Description: Altering(6)existing circuits for associated tenant improvement
Owner Applicant Contractor
VIRGINIA MASON CLINIC H&M ELECTRIC INC H&M ELECTRIC INC
1100 9TH AVE S PO BOX 799 HMELEI*077KR(5/19/15)
SEATTLE WA 98101-2756 MARYSVILLE WA 98270 PO BOX 799
MARYSVILLE WA 98270
Additional Permit Information
Is this an Online or O.T.C.application? No Is Use Educational or Institutional? Yes
Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial 6
PERMIT EXPIRES Tuesday, July 15, 2014
Permit Issued on Thursday, January 16, 2014
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the u will be in accordance with the laws, rules and regulations of the State of Washington
nd the City of Federal Way.
Owner or agent: Date: //l6///4//4
THIS CARD IS TO MAIN ON-SITE i. •
CITY OF waConstruction In ection Record
-
Fe era! WayINSPECTION REQUESTS: (253) 835-3050
PERMIT #: 14-100096-00-EL Address: 33501 1ST WAY S
Project: VIRGINIA MASON CLINIC FEDERAL WAY, WA 98003-6208
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) - El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
o Pool Bonding(4195) 0 Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) El Rough Electrical(4225) E Ceiling Cover(4020)
Approved Approved Approved
By Date By .\•
‘ ./, Date r\ `r 1 t By Q_Nit.t ,.� _��Date t t\
El Final-Electrical(4055) �l
Approved
By '"44",›1 Date ( Q ,
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
CEIVED
Q ELECTRICAL
CITY OF ,JAN 0 8 2014
Federal WadCITY OF FEDERAL WAY
PERMIT APPLICATION
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CDS
PERMIT NUMBER - 1 6 O O `C0
_ 00 i: 4a4
_ _____
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 co 1 _1•`-r- ��y S
PROJECT VALUATION ASSESSOR''S•TAX/PARCEL# CURRENT/PROPOSED USE
s 2. 5) b ,-, 5 (0 6 0 li 0 i � ;ill : C----•
PROJECT NAME
(Tenant or Homeowner Last Name) y ' 3 1 n ;- t` ( ,o r% r C L /�4 G
U
PROJECT DESCRIPTION C�=1144/1I 41 1") i' t 7t:) 6'- i S ti r 1`' �-`�J l
Detailed description of work to •l; - ( 'C C-1 OCt)i-rg
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER V c lr'P� yelra ilc��l/1 (24,6)3Y (- i7t f3
MAILING ADDREJ E-MAIL
I tae. N;r'1--k
CITY STATE ZIP FAX
IC ref) ?510 t ( ) -
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL —C7 173 o>< i q 1
CONTRACTOR CITY STATE ZIP FAX
r %% jt/ WA / /34 )10
)2CONTRAENSE# EXPIRATION DATE FI- YBUSIN #
•r ✓ifi C L ( 077 le.7,
1// 3c2 //9 / (7" 93 -/o n7-60-3L-
NAME
l-C LNAME PRIMARY PHONE
APPLICANT `j i'�I �� - . _ ‘_.1-\e___ (560 )6? g3-P,5-e)
MAILING ADDRESS cQ E-MAIL
CITYSTATE ZIP FAX
/ ' Jl'/ lie- 149 qy vl ) tj )EjJ-
75o
NAME PRIMARY PHONE
PROJECT CONTACT -----,_„.eqyine r�� `�1•€.c = (2.04. )17 9 _ 2 3o0
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. l
----BSIGNATURE: �� DATE G / 7 ' /L
PRINT NAME: r r-al - P�(-
Bulletin#160—January 1,2013 Page 1 of 2 k:AHandouts\Electrical Permit Application