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16-101906
_ ._ __ _ , , _ - City of Federal Way FINALED . . Electrical Community&Econ.Dev.Services PFILEermit #: 16-101906-00-EL 33325 8th Ave S Federal Way,WA 98003 Inspection Request Ph:(253)835-2607 Fax (253)835-2609 p q st Line: (253)835-3050 Project Name: SEA-MAR CLINIC Project Address: 31405 18TH AVE S Parcel Number: 092104 9233 Project Description: Install the low-voltage for internet,phone and sound.The project consist of running Cat5e cables and°running(2)wire conductors. Owner Applicant Contractor SEA-MAR COMM HEALTH CENTER LUIS GOMEZ OWNER IS CONTRACTOR 1040 S HENDERSON ST 1040 S HENDERSON ST SEATTLE WA 98108 SEATTLE WA 98108 Additional Permit Information Electrical Work Valuation? .23000 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. 1 PERMIT EXPIRES Thursday, April 20, 2017 Permit Issued on Wednesday, April 20, 2016 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy an the use will in accordance with the laws, rules and regulations of the State of Washington and the Ci of Federal Way. Owner or agent i`J hit-e 2.— Date: 64/_Z0— M P/Aldi ED DATE INSPECTOR AREA AND 'TYPE OF INSPECTION [411c —z4— I& S �� L �� i_ IJP. ?/�� ' q— 6 _ � : , - --- c ( \c THIS CARD IS TO REMAIN ON-SITE Federal Wa Construction Inspection Record y INSPECTION REQUESTS: (253)835-3050 PERMIT#: 16-101906-00-EL Address: 31405 18TH.AVE S Project: SEA-MAR COMM HEALTH CENTEF FEDERAL WAY, WA 98003-5404 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. El UFER Ground (4295) El Ditch cover(4030) 0 Slab/Concrete Floor(4255) Approved Approved Approved to place concrete By Date By Date By Date El Pool Bonding(4195) 0 Temporary Power(4275) ❑ Service(4235) Approved Approved Approved By Date By Date By Date O Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020) Approved Approved Approved By Date Bc Date =(()--(t� Bc- c-- DateCQ— Q O Final-Electrical(4055) Approved 13•1-- --> Date\( (e (6D El Rough ElectricalEl Final Electrical El Right of Way Approved Approved Approved By Date By Date By Date CITY OF RECEIVED ELECTRICAL Federal Way APR 2 2016 PERMIT APPLICATION Ca d I OF FEDERAL YERRMrIT NUMBER ) c - / QL°i V »CC/// 6 1,. - a CDS ii SUITE/UNIT/SPACE# SITE ADDRESS: c�1 i 405 0c_,1 �v ex�V f. O, 4\ 'Ce X401\ Wan wap. PROJECT VALUATIONI �/ `/ASSESSOR'S TAX/PARCEL# � CURRENT/PROPOSED USE $ GT V_ _QQ 0 9 1 0 / - / 'Z 3a P(Tenant or Homeowner Last Name) 5E11 m(k c___, ,p1 t\ \ e A. a%./ \-vve toy-, Vollaq,o ir..\e,rnel-\Vt,©ty)cu4 PROJECT DESCRIPTION (h&c.) VIDV- \V`e- `lPs'o,Sh,e- "‘"v16-cAck ,d, iak Aje_ Cak-Se- Detailed description of work to C `r ®' v i � ��' `- \( _ ami a -two 'ke. co be included on this permit only ®`�f' �..v`^^v.kYc� a%)do.f cam c-‘i.e, S`Tejk€s, a.ylci ticidiv et 4- erii NAME PRIMARY PHONE PROPERTY OWNER9 (706) a0 6 - 1463 MAILING ADDRESS E-MAIL (OLIO la eilatscS6*411,0\-5G61m-C2-0CaSoatitu:vcci CITY STATE ZIP FAX 5eOPAC uj4 q%0 C6 ( ) NAME _ . PRIMARY PHONE Owriev ( ) - MAILING ADDRESS E-MAIL ELECTRICAL CONTRACTOR CITY STATE ZIP FAX ( ) - WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / NAME PRIMARY PHONE APPLICANT \.-t?\S G.Ovr`e 7, (206 ) O - 21 bb MAILING ADDRESS E-MAIL \6 He, S Wei° A y-So e• L SGLei r.Z.&O Wavnc@v c lic• � CITY STATE ZIP FAX e 1ti*e. 'N. qg Co$ ( ) - NAME - 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 a part of this application. SIGNATURE: ,4 AC704 e A DATE Q)", — 0— [C PRINT NAME: `,n,l>;S tz Bulletin#160–April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application