16-104798City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: MOND
Project Address: 32604 39TH AVE S
Project Description: 0-200 amp panel replacement
Electrical
Permit #:16 -104798 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 152104 9096
Owner
Applicant
Contractor
ROBERT WAYNE MOND
OVERLAKE ELECTRICAL INC
OVERLAKE ELECTRICAL INC
32604 39TH AVE S
PO BOX 40614
OVERLEI017LJ (6/15/17)
FEDERAL WAY WA 98001-9652
BELLEVUE WA 98015
PO BOX 40614
BELLEVUE WA 98015
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
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PERMIT EXPIRES Thursday, 28 September, 2017
Permit Issued on Wednesday, September 28, 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. 4C4
Owner or agent: Date: �
FINALED
carr of
Federal Way
PERMIT #: 16104798 00
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
Address: 32604 39TH AVE S
Project: ROBERT WAYNE MOND FEDERAL WAY WA 98001-9652
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.
®
UFER Ground (4295)
®
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
0
UFER Ground (4295)
Ditch cover (4030)
Slab/Concrete Floor (4255)
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
®
Temporary Power (4275)
®
Service (4235)
0
Pool Bonding (4195)
Temporary Power (4275)
Service (4235)
By
Date
By
Date
By
Date
®
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
0
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
By
Date
By
Date
By
Date
Final - Electrical (4055)
lectrical (4055)
B �' Date SCJ Z
Rough Electrical
El
Final Electrical
0
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF V;&�
Federal Way
PERMIT NUMBER _I v _ ` C) ` :7 cl q _ 00
ELECTRICAL
e
SEP 2 8 2016
CITY OF FEDERAL WAY
A ,V 9; S
SITE ADDRESS: (/`� //x1
E/UNIT/SPACE #
PROJECT VALUATION
c5o �
ASSESSOR'S Sz OR'S TAX/PARCEL # � - � O �
5 c O �- —
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
M Como
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
t ir Lr9 N L
PROPERTY OWNER
NAME
R o n uza (W D MO
PRIMARY PHONE
(sq S10- qsocy
MAILING ADDRESS
I (90 A - `'jC? +� tivE S.
E-MAIL
CITY
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
MAILING ADDRESS
F,0- (Di
E-MAIL
CITY
r_ -
STATE
U -R
I ZIP
i 015;
FAX
( ) -
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
OV L tiL2/1 -7
FEDERAL WAY BUSINESS LICENSE #
poly I v 3 a �v-ajn
APPLICANT
NAME
o M -
PRIMARY PHONE
( ) 3 G
MAILING ADDRESS
E-MAIL
CITY
STATE I
ZIP
FAX
( )
PROJECT CONTACT
NAME 'y
PRIMARY PHONE
(SLj)(a O
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.
1 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 apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application