13-103867r N
City of FederalLSJ
Community & Econ. D
33325 8th AvFederal Way, WAPh: (253) 835-2607 Fax:
0
e
y
Electrical
Permit #: 13 -103867 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: FEDERAL WAY VISION CENTER
Project Address: 32717 1ST AVE S Unit 6 Parcel Number: 697900 0050
Project Description: Lighting retrofit.
Owner
A121211can
Contractor
SANDRA FRIEDMAN
M JONES ELECTRIC
M JONES ELECTRIC
RICHARD L BUSHEY
27726 131ST CT SE
MJONEJE90400 (9/20/14)
30506 12TH PL SW
KENT WA 65080
27726 131 ST CT SE
FEDERAL WAY WA
KENT WA 65080
98023
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 Sunday, March 2, 2014
Permit Issued on Tuesday, September 3, 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
nd �ty of Federal Way.
F11
Owner or agent: Date:
THIS CARD IS TOMAIN ON-SITE F
CITY OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 13 -103867 -00 -EL Address: 32717 1ST AVE S Unit 6
Project: SANDRA FRIEDMAN FEDERAL WAY, WA 98003-5758
Scheduled inspections may be failed if this card isnot 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.
❑ Final - Electrical (4055)
Approved
By 0,066 Date 10 \ 3
ElApproved❑
UFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
El
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
❑ Final - Electrical (4055)
Approved
By 0,066 Date 10 \ 3
ElApproved❑
Rough Electrical
❑
Temporary Power (4275)
El
Service (4235)
By
Pool Bonding (4195)
Approved
Date
Approved
Date
Approved
By
Date
By
Date
By
Date
Ceiling Cover (4020)
❑
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
Date
By
Date
❑ Final - Electrical (4055)
Approved
By 0,066 Date 10 \ 3
ElApproved❑
Rough Electrical
Final Electrical
Approved
El
of Way
Approved
By
Date
By
Date
By
Date
RECEIVED
V& SEP 03 2013 ELECTRICAL
Federal Way CITY FEDEPAL
WAY PERMIT APPLICATION
% (� O
SITE ADDRESS: 3 � 7 57 AVE 5b�1 }�
SUrrE/UNrr/SPACE #
#, &
PROJECT VALUATION
$ 9/0
ASSESSOWS T=PARCEL #
— — — — — — - ----
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
_ p _
I)t R i' L- IN A */ y i S [ Q N GEN ( " r?-
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
1 O IT
PROPERTY OWNER
NAME
PRIMARY PHONE
{ ) -
KAILING ADDRESS
EMAIL
CITY
STATS
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAM )ONC5
PRUWA" PHONE
(2153) SZO C- (Z 33
MAILING ADDRESS
Z 7 7 % C I S15-
R -MAH,
cm-� �
Iv 1
STATE
wA
z�
98a �
FAX
( )
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
62 E=F,J1r d o 0 91 z.o it y
FEDERAL WAY BUSINESS LICENSE #
2.0 "/ � 0 7 -aa-SL
APPLICANT
NAME
PRIMARY PHONE
( )
MAILING ADDRESS
E-MAIL
Crry -
STATS I
Z1(P
FAX
l
PROJECT CONTACT
NAME LO R �4 PH 6VI,y)E R
PRIMARY PHONE
i
(.ys -zgg
1 certify under penalty, of perjury that I am the property owner or authorised 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 cert(y that 1 will comply with
all applicable City of Federal Way regulations pertaining to the work authorised 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 envIronnumtal 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 jlled 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 his appUi n.
SIGNATURE. DATE 3
PRINT NAME -
Bulletin # 160 —January 1, 2013 Page 1 of 2 kMandoutsTlectrical Permit Application