16-100730Clty of Federal Way
Conimunity & Econ. Dev. Services
33325 Sth Ave S
Peder41 Way, WA 98003
Ph: (253) 935-2607 Fax: (253) 835-2609
Project Name: PROMINENCE HEALTH PLAN SERVICES
Project Address: 33820 WEYERHAEUSER WAYS
Electrical
Permit #: 16 -100730 -00 -EL
Inspection Request Line: (253) 835-3050
Project Description: Install 120 V power to projector and screen in suites 201 and 206
Parcel Number: 215466 0040
Owner
ARplicant
Contractor
M J R DEVELOPMENT
BURKETT AND SONS ELECTRIC LLC
BURKETT AND SONS ELECTRIC LLC
6725 116TH AVE NE
1518 SE CAMANO DR
BURKESE883KB (5/2/16)
KIRKLAND WA 98033
CAMANO ISLAND WA 98282
1518 SE CAMANO DR
CAMANO ISLAND WA 98282
Additional PermitInformation
Electrical Work Valuation?....................................500
Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Circuits - Commercial .................... 2
Is this an Online or O.T.C. application?.................Yes
Service greater than 999 Amps? .............................No
PERMIT EXPIRES Wednesday, February 8, 2017
Permit Issued on Tuesday, February 9, 2016
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 b in accordance with the laws, rules and regulations of the State of Washington
1 and the CiW of Federal Way.
Owner or agent:
FINALED
Date: "( of — /-C
CITY OF
Federal Way
PERMIT #:
Project:
16 -100730 -00 -EL
M J R DEVELOPMENT
THIS CARD IS TOMAIN ON-SITE
Construction In ection Record
INSPECTION REQUE TS: (253) 835-3050
Address: 33820 WEYERHAEUSER WAYS
FEDERAL WAY, WA 98003
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
Temporary Power (4275)
Floor (4255)
Approved
E:]
Approved
Approved to place concrete
By
Date
By
Date
By
Date
El
Pool Bonding (4195)
E]
Temporary Power (4275)
Right of Way —�
Approved
E:]
Service (4235)
Approved
Date
Approved
Date
Approved
By
Date
By
Date
By
Date
E]
Feeders/Sub-panels (4045)1:1
Rough Electrical (4225)
E]
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
0
Final - Electrical (4055)
Approved
By
Wn Date 9- I I toI IL'
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way —�
Approved
By
Date
By
Date
By
Date
CITY OF VAA
Federal Way
PERMIT NumBER
ELECTRICAL
PERMIT APPLICATION
RECEIVED
�O
FEB 0 9 2016
SITE ADDRESS: 3300� 0
biPf V -Sec-,-H
CDS WAY
PROJECT VALUATION
� C
ASQl/11R'S TAR/PARCEL
5
i{ � � _ O � � �
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
_
r ,�
C�
� l
Q M VN L -) WC 4 t-- L ! f�
I �
PROJECT DESCRIPTION
' �-LaL
FftiA
At &J I �C&01-11(66
70
-
/
Detailed description of work to
be included on this permit only
105
1� su�C
)0/ 66
`�PRIMARY
PROPERTY OWNER
NAME
I;q -
PHONE
( ) -
MAILING ADDRESS
W 5f
E-MAIL
CITY ,( �� �� y� �
Ly"' `;00
pST�A�T�
V v
ZIP22L,�=
FA%
-
NAME
-c-Ir
PRIMARY PHONE
MAILING ADDRESS
%:� -
C+�w1
io l �E
EMAIL
ELECTRICAL
CITY
STATE
ZIP
92
FAX
( -
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE #
_
EXPIRAT10jr DATE
FEDERAL WAY BUSINESS LICENSE #
i� (A z ec�
NAME
/ /
b
PRIMARY PHONE
APPLICANT
( )
MAILING rDDRWS
EMAIL
CITY
STATE I
ZIP
( FAX
)
PROJECT CONTACT
NAME
1 -to
r '
U rK
PRIMARY PHONE
( - UI ( i
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 ch cl im), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim co of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci a of this application. p
SIGNATURE:
PRINT NAME:
a -�,- /�-,
Bulletin # 160 — January 1, 2013 Page I of 2 k:\1-Iandouts\Electrical Permit Application