14-102182 • • , E lectriccal
City of Federal Way Permit #: 14-102182-00-EL
Community&Econ.Dev.Services
33325 8th Ave S
Federal way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 Fl LE
Project Name: HALLMARK MANOR
Project Address: 32300 1ST AVE S Parcel Number: 172104 9073
Project Description: 3-emergency stops for boiler.
Owner Applicant Contractor
HALLMARK CARE CENTER KIRBY ELECTRIC INC KIRBY ELECTRIC INC
3001 KEITH ST NW 4826"B"ST NW SUITE 101 KIRBYEI077BN(1/13/15)
CLEVELAND,TN 37312 AUBURN WA 98001 4826"B"ST NW SUITE 101
AUBURN WA 98001
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
Circuits-Commercial 1
PERMIT EXPIRES Saturday, November 8, 2014
Permit Issued on Monday, May 12, 2014
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: Date:
FINALED
_ • THIS CARD IS TO ,MAIN ON-SITE
'` .P Construction In ection Record
CITY of '
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 14-102182-00-EL Address: 32300 1ST AVE S
Project: HALLMARK CARE CENTER FEDERAL WAY, WA 98003-5762
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) 0 Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
. .
El Pool Bonding(4195) ❑ Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) ❑ Rough Electrical (4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
.
0 Final-Electrical(4055)
Approved
By in. Date S 114 113
❑ Rough Electrical CI Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
p. IVSD .
MA`f 12 2614 ELECTRICAL
OF L
Federal WaycI OF FEDE�`LwAY PERMIT APPLICATION
� J CpS
PERMIT NUMBER / y _ /007 7 8 ? _ e L
SITE ADDRESS: S 2- is -I--
cmL.:::_a_.,. SUITE/UNIT/SPACE#
PROJECT VALUATION may) ASSESSOR'S TAR/PARCEL f CURRENT/PROPOSED USE
I,' !r _
PROJECT NAME 7��ti /C /_ nI� D� —
(Tenant or Homeowner Last Name) V _f�//
PROJECT DESCRIPTION
Detailed description of work to , S 71/1y � e XJ c� 13 C7 IQ�
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be included on this permit only !
NAME /� /� _
J //V�AM� I a4� PRIMARY PHONE
PROPERTY OWNER �``l/`/'/ill// G/ ( )
MAILING DRESS
E-MAIL
CITY STATE ZIP FAX
( )
NAME
eo lJ'/� I� C PRIMARY PHONE
MAILING ADDRESS l 1 ( )
ELECTRICAL Lf 8a(p' j.. s , IV Sle, I ?? ! E-MAIL
CONTRACTOR clix STATE ZIP FAX
`�fzL /1 i / ) ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME
PRIMARY PHONE
APPLICANT ( )
MAILING ADDRESS
E-MAIL
CITY STATE ZIP FAX
(
NAME ...j.„..c, .� 1 )PRI PHONE
PROJECT CONTACT
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: �f c.�"' DATE S — /Z — f—/
PRINT NAME: j / (((
Bulletin#160—January 1,2013 Page 1 of 2 k:AHandouts\Electrical Permit Application