14-105612 Electrical
City of Federal Way w
Community&Econ.Dev.Services Permit #: 1 -105612-00-EL
4
33325 8th Ave S
Federal Way,Fax
(2553)3 I
Ph :(253)835-2807 Fax: ` Inspection Request Line: (253)835-3050
. 835-2809 a1 lams �
Project Name: FRED MEYER
Project Address: 33702 21ST AVE SW Parcel Number: 930100 0010
Project Description: Install low voltage data wiring for(12)public monitors in cosmetic area and apparel fitting
rooms.
•
Owner Applicant contractor
FRED MEYER INC APPLIED TECHNICAL SYSTEMS INC APPLIED TECHNICAL SYSTEMS INC
PO BOX 42121 7015 SW MCEWEN RD APPLITS066KD(5/4/16)
PORTLAND OR 97242 LAKE OSWEGO OR 97035 7015 SW MCEWEN RD
LAKE OSWEGO OR 97035
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
Low Voltage-Other(Commercial I
PERMIT EXPIRES Sunday, April 26, 2015
Permit Issued on Tuesday, October 28, 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
nd the City of Federal Way.
Owner or agentDate: /60/2.9/y
1;14,N100 °'
• THIS CARD IS TO MAIN ON-SITE
Co
CITY OF - 0nstruction In ction Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 14-105612-00-EL Address: 33702 21ST AVE SW
Project: FRED MEYER INC FEDERAL WAY, WA 98023-7762
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.
0 UFER Ground(4295) ❑ Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) .❑ Temporary Power(4275) �0 Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) �0 Rough Electrical(4225) ' '0 Ceiling Cover(4020) '
Approved Approved Approved
By Date By Date By Date
•
0 Final-Electrical(4055)
Approved
By 044 Date 11 (l I izt
El Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
S •
CITYOF w.=AL ELECTRICAL
Federal Way PERMIT APPLICATION
PERMIT NUMBER 4 _ 1 0 G 1 2 _ RECEIVED
W
- - OCT 282014
SITE ADDRESS: €l1 ' RAL WAY
33702 1 g. Ave w. CDS
PROJECT VALUATION ASSESSOR'S TAX/PARCEL f CURRENT/PROPOSED USE
$ 36V6 930 tO0 _ co / 0
PROJECT NAME
(Tenant or Homeowner Last Name) /t/d /`Git ee F e' S
Insi- li 12. "ea)/I Vie 4.,.) NterniIr-S irn eo$me,4eS
PROJECT DESCRIPTION &h d Ap p g 4 hw rc j D"ODri4 S
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER Frei me„ G,_ C gs„) ( Z.S'3) eirZ.- 0/00
MAILING ADDRESS E-MAIL.
3 S 16 a Zt 34' A,vC. S cJ
CITY ,,STgATE ZIP FAX
VeCt/e J EL l i tij d ehl T•apk q?rPA3 ( ) -
NAME 4 Art I eta.! S S kL/ S - PRIMARY PHONE _ _
•'• AS /ice/ T ee, is! , j►,S4_s (603 )48Y - 444/
MAILIN DRESS E-MAIL
ELECTRICAL 7o15' Sew /lii &., /Zd. Sbakes @../4-TSo, - . to
CONTRACTOR CITY STATE ZIP
/A,ke DSc veii Di ''7035 (tai s4&F 4&
WA STATE CONTRACTOR' LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE/
dipt<fs 0(04)&0 S / c
N
PRIMARY PHONE
APPLICANT 5 { {S ('$GD ) ({,Sjo Q GS'7
MAILING ADDRESS
E-MAIL
SY 0 .fin e-e-c S Ay 001-- �fi�'!50/401. cern
CITY STATE ZIP
lick W.l!a "al. Ct e 4 E( (206)C-7 - /5-41tapNAME PRIMARY 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 art of this application.
SIGNATURES///
�/
JJ DATE /0/Z404/ •
PRINT NAME: (5I t'� ECGICS
Bulletin#160 January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application