16-102680 .,..— Electrical
City of Federal Way Permit #: 16-102680-00-EL
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Inspection Request
Ph:(253)835-2607 Fax:(253)835-2609 p q est Line: (253)835-3050
Project Name: HOUSE
Project Address: 29654 2ND AVE SW Parcel Number: 513730 0070
Project Description: Wiring for exhaust fan and add GFI for newly converted powder room.
Owner Applicant Contractor
DUANE A HOUSE DUANE A HOUSE OWNER IS CONTRACTOR
29654 2ND AVE SW 29654 2ND AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Electrical Work Valuation? 500 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 2
PERMIT EXPIRES Friday, June 2, 2017
Permit Issued on Thursday, June 2, 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 ith the laws, rules and regulations of the State of Washington
and th City of Federal Way.
Owner or agent C LLLL�, Q:GL� Date: Z Zf9`6
FlHAL ;ED
THIS CARD IS TO REMAIN ON-SITE
FederalConstruction Ins ection Record
Way INSPECTION REQU}TS: (253)835-3050
PERMIT#: 16-102680-00-EL Address: 29654 2ND AVE SW
Project: DUANE A HOUSE FEDERAL WAY, WA 98023-3505
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) El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) 0 Temporary Power(4275) El 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 img Date 1 I I ilL,
By Date
O Final-Electrical(4055)
Approved
By U'43 Date .? I (t' I I L
O Rough Electrical El Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
.
ELECTRICAL
CITY OF
Federal Way PERMIT APPLICATION
'UN p 2 2016
V 2
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FEDERAL� MIT NUMBER 1 SCJ - 10E
C 0 - ��
COS 111
SUITE/UNIT/SPACE#
SITE ADDRESS: 2 % c// 2 h c Atie, 5' W �� �a �4�Y �M
PROJECT VALUATION !! /ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
foo 5 1 3 7 3 U - QQ 7 0
PROJECT NAME
(Tenant or Homeowner Last Name) • 1--1 o u S e c r l rai 2' `tom,� re
`J f ` G C//_
x.
PROJECT DESCRIPTION 1 E I
Detailed description of work to
be included on this permit only
NAME / �,,�, PRIMARY PHONE
PROPERTY OWNER I� l) Ah/' J-Jou5 ( las 54(1
(17-3s-
MAILING ADDRESS E-MAIL
S11 (19 Sf . Cal hoose e (J ark
CITY STATE ZIP FAX v
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NAME PRIMARY PHONE
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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 0/01-E C 5 6/1)2-'2_ -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
PROJECT CONTACT NAME PRIMARY PHONE
v - ( 206) g2(- V235
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 thehecity as a part of this application.
SIGNATURE: V - P DATE 6/2/ 16
PRINT NAME:__ a,0.0 140(
Bulletin#160-April 14,2016 Page 1 of 1 kA-landouts\Electrical Permit Application