16-103352City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
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Permit #: 16 -103352 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: CVS PHARMACY
Project Address: 33520 21ST AVE SW Parcel Number: 132103 9098
Project Description: Install 1200amp service for new CVS Pharmacy.
Owner
Al2Rfican
Contractor
WASHINGTON CVS PHARMACY LLC
PATTY FULLER
FULLER ELECTRIC (ELECTRICAL)
100 WEST MINISTER ST SUITE 1500
FULLER ELECTRIC INC
FULLEEI027BK (1/12/18)
PROVIDENCE RI 02903
1220 S 356TH ST SUITE A-5
37107 12TH AVE S SUITE A-5
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
.Additional Permit Information
Electrical Work Valuation?....................................250000 Is this an Online or O.T.C. application? ................. No
Is Use Educational or Institutional?.......................No Service greater than 999 Amps? ............................. No
Electrical Fixtures
New Service: 0 - 100 amps (Comm 1
PERMIT EXPIRES Thursday, July 27, 2017
Permit Issued on Wednesday, July 27, 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 be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date:
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ederal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE ,
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
16 -103352 -00 -EL Address: 33520 21ST AVE SW
WASHINGTON CVS PHARMACY LI FEDERAL WAY, WA 98023-2874
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
UFR Ground (4295)0
Ditch cover ( 03)
Temporary Power (4275)
Slab/Concrete Floor (42 5)
Approved
Approved
Approved
By
Approved to place concrete
Datep_Z I
By
Date
By
b 4 Date 10 11410,
0 Final - Electrical (4055)
Approved
By ryrj Date 30
Pool Bonding (4195)
0
Temporary Power (4275)
Date
Approved
Final Electrical
Approved
Approved
By
Date
By
Date
By
Date
0
Feeders/Sub-panels (4045)
0
Rough Electrical (4225)
Approved
Approved
By
Date I
By
Date
0 Final - Electrical (4055)
Approved
By ryrj Date 30
Service (4235)
Approved
By
Date
Right of Way
Approved
Final Electrical
Approved
Ceiling Cover (4020)
By
Approved
Datez: -
Right of Way
Approved
Final Electrical
Approved
Rough Electrical
Approved
By
Date
By
Date
By
Date
CITY OF A
Federal Way
#1
y
!"`.. RECEIVED
m t 3 ZA ELECTRICAL
CITY OF FEpEPAL WAY
GDS/
PERMIT NUMBER / O S 3 S Z _ i�
PERMIT APPLICATION
I cert(fy 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(fy 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 farther 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 clairr4, 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 apart of this application.
SIGNATURE: DATE 7/12/16
PRINT NAME: Anthony Moore
PERMIT CENTER + 33325 8t', Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(��cityoffederalway.com
Bulletin #160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
SUITE/UNIT/SPACE M
SITE ADDRESS: 33520 21ST AVE. SW, FEDERAL WAY, WA
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL N
CURRENT/PROPOSED USE
$ 250,000
1 3 2 1 0 3- 9 0 9 8
PROJECT NAME
(Tenant or Homeowner Last Name)
CVS/pharmacy Store #10659
Electrical construction of new CVS store, includes site improvements and ROW
illumination
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
The Velmeir Companies, Mick Chong
( 770) 881 -3466
MAILING ADDRESS
E-MAIL
5757 W. Maple Road
CITYSTATE
ZIP
FAX
West Bloomfield
MI
48322
( ) -
NAME
PRU ARY PHONE
Fuller Electric
( 253) 661 - 7181
MAULING ADDRESS
E-MAIL
ELECTRICAL
1220 South 356th Street, Suite A5
Anthony@FullerElec.com
CONTRACTOR
CITY
STATE
ZIP
FAX
Federal Way
WA
98003
( 253 ) 661 - 6956
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
FULLEE1027BK 01/ 12 / 18
19 -93 -103364 -00 -EL
NAME
PRndARY PHONE
APPLICANT
Fuller Electric
( 253 ) 661 - 7181
MAILING ADDRESS
B -MAIL
1220 South 356th Street, Suite A5
Anthony@FuIlerElec.com
CITY
STATE
ZIP
FAX
Federal WayWA
98003
( 253) 661 - 7181
PROJECT CONTACT
NAME
Anthony Moore
PRIMARY PHONE
( 253) 661 - 7181
I cert(fy 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(fy 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 farther 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 clairr4, 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 apart of this application.
SIGNATURE: DATE 7/12/16
PRINT NAME: Anthony Moore
PERMIT CENTER + 33325 8t', Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(��cityoffederalway.com
Bulletin #160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application