16-102520 Elari�al
Tunicty of Federal Way Permit #: 16-102520-00-E L
Community&Econ.Dev.Services � '
33325 8th Ave S
Federal Wa ,WA 8003
Ph:(253)835-2607 Fax:(253)835 2609 FILE
Inspection Request Line: (253)835-3050
Project Name: MERRILL
Project Address: 28412 14TH AVE S Parcel Number: 720300 0515
Project Description: Add(1)circuit for GFCI in bathroom and wiring for bath fans and lights.
Owner Applicant Contractor `
PATRICIA MERRILL CESAR GARCIA NORTH POINTE ELECTRIC
28412 14TH AVE S NORTH POINTE ELECTRIC NORTHPE901ML(7/13/16)
FEDERAL WAY WA 98003-3156 3519 N BENNETT ST 3519 N BENNETT ST
TACOMA WA 98407 TACOMA WA 98407
Additional Permit Information
Electrical Work Valuation 900 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Wednesday, May 24, 2017
Permit Issued on Tuesday, May 24, 2016
I hereby certify that the a.. information is correct and that the construction on the above described property and
the occupancy and the - ill be in accordance with the laws, rules and regulations of the State of Washington
and t - ity of Federal Way.
Owner or agent: Date: 5 y/ro
.
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record - --
CITY OE.
Way INSPECTION REQUESTS: (253)835-3050 +
PERMIT#: 16-102520-00-EL Address: 28412 14TH AVE S
Project: PATRICIA MERRILL FEDERAL WAY, WA 98003-3156
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.
o UFER Ground(4295) El Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
.
O Feeders/Sub-panels(4045) El Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Dates Date 6-3___(L, By Date
ID Final-Electrical(4055)
Approved
aZi Date -Z<_ (..,::,
O Rough Electrical CI Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
A. ELECTRICAL
CITY OF : RECEIVE)
Federal Way PERMIT APPLICATION
MAY 232016 '
CITY OF FEDERAL "' 1uiIT NUMBER (TO _ ^t �1 5 Z- C) - ' L.
CDS
SUITE/UNIT/SPACE#
SITE ADDRESS:
63 i PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ ?&I)1 Ob 7 2 0 -aj 0 0 - 0 5 1 .5'
PROJECT NAME
(Tenant or Homeowner Last Name) Ai1 e r c C
PROJECT DESCRIPTION /J
Detailed description of work to nag6 ' ,�c1 ,/' //WI J1/ cN Ck r(v/'f Fc-k-
be included on this permit only r, l t /
r Co r < x.2.41 ' s mud, /(qh S
NAME r PRIMARY PHONE
PROPERTY OWNER '\t1/1-e K'r( LC ( ) -
MAILING ADDRESS E-MAIL
2(8'11 IL14 , /1, AS
CITY STATE Z FAX
Fe's✓4 L u/ -ci (A 6 ( ) -
NAME PRIMARY PHONE
p02.,-.1--k op vt . @�" e(C (z5--3 ,3,--o- 5�cP6
MAILING ADDRESS �, E-MAIL
ELECTRICAL
(-2-
ELECTRICAL P, a . �1.Y '- S
CONTRACTOR CITY STATE ZIP FAX
r'04-(7 C44,44- WC 0 o7 ( ) -
tS ,� WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
.{! C.\JV� /
NAME (7 - PRIMARY PHONE
S
APPLICANT .fa C 49)/t'? ( ) -
MAILING ADDRESS E-MAIL
I 9y�,5 CITY STATE ZIP FAX
✓✓✓___��,
( )
NAME ‘ PRIMARY PHONE
PROJECT CONTACT
®fie -vl
g-5-5 )3e/ - 26.3
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 . 'ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t = .-ty as a part of this applica :n.
SIGNATURE: v DATE 5/2z4
PRINT NAME: L-4) • V .. a....,
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application