16-101858 -
Electrical
Fag--
City of Federal way Permit #. 16-101858-00-EL
Community 8 Econ.Dev.Services •
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: NORTHWEST CHIROPRACTIC CENTER
Project Address: 34730 PACIFIC HWY S Parcel Number: 202104 9145
Project Description: Replace rooftop subpanel&feeders.
Owner Applicant Contractor
LORRI A NICHOLS LLC SUSAN MATTHEWS ALL CLIMATE HEATING&A/C
34730 PACIFIC HWY S ALL CLIMATE HEATING&A/C (ELECTRICAL)
FEDERAL WAY WA 98003 17527 NE 67TH CT ALLCLCI933N7(8/27/17)
REDMOND WA 98052 17527 NE 67TH CT
REDMOND WA 98052
•
Additional Permit Information
Electrical Work Valuation? 3000 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No Service greater than 999 Amps? No
Electrical Fixtures
Alt.Srvc/Feeder 0 to 200 amps(C 1
PERMIT EXPIRES Saturday, May 13, 2017
Permit Issued on Friday, May 13, 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 t►- -ws, rules and regulations of the State of Washington
Owner or aa the C' o ederal Way.
_ Date: S--// 3 /�..co /6
FINALED
THIS CARD IS TO REMAIN ON-SITE
•
CITY OF � . ..
Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-101858-00-EL Address: 34730 PACIFIC HWY S
Project: LORRI A NICHOLS LLC FEDERAL WAY, WA 98003-6821
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) 0 Ditch cover(4030) E Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) '0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
o Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved /" .
`�
Rough Electrical 0Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date
MEWED
CIMOF
APR 18 2016 ELECTRICAL
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER 1 _ I 0 l y
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SUITE/UNIT/SPACE#
SITE ADDRESS; ?L4"-I-3(2r p -' �L (_... /y
PROJECT VALUATION ..
A T 4 C ASSESSOR'S TAICARCEI,# - ^_ / zi 5 CURRENT/PROPOSED USE
PROJECT NAME Z(/.F`1 !// (•I/►j
(Tenant or Homeowner Last Name) ,, Lore( Vi c-I L O
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rte' ouvvip on.s Ha ry)
PROJECT DESCRIPTION L �^ ) r p"
Detailed description of work to 6 c o I d,el lqa 0 T G�/p 5 V!IJ Got,L 4- F ectue j
be included on this permit only ! �1
NAME
PROPERTY OWNER &, Lc (i kCo S (2- 3 1M
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MAILING ADDRESS -(\�. C E-MAIL
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STATE ZIP FAX C nh
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es_ way
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NAME ' I CA ( V 151(1(-/i ( 1 5) 7'f 4 PR7 1
MAILING ADDRESS 11 rr I� _J�„ Cj • n E-MAIL /• �'An/� .p
ELECTRICAL (-769=9- l� l� '` `)F 1 I • ' c l/l 'Il.11 m6/ I� ,
CONTRACTOR 19 STATE ZI FAX 14/.4
A STA
Y BUSINESS
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W'\ CL 33/ )3LICENSE ... /o'' 1 / I V N FEDERAL
ED-.o p/ •LICENSE
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NAME PRIMARY PHONE
APPLICANT °VMS ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
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PRIMARY
PROJECTCONTACT r�n Ph--+P)6HONE' (14e;) (-1 -P3p-7-9-
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 o Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the
issuance of this •erm does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or nviron ntal laws.
I further agr= to hol• armless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigatio and def e of such claim), ich may be made by any person,including the undersigned,and filed against the city,
but only where = •i arises out of - eliance of the city, including its officers and employees, upon the accuracy of the
information s •• led to t c ty as a pa • t application.
SIGNAT - : / w' II
S/ DATE Ll�-_/` `,
PRINT N• E: P 7
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application