16-103281 r Electrcl
Cityof Federal Permit #: 16-103281-00-EL
Community&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: GORHAM
Project Address: 200 SW 292ND ST Parcel Number: 119600 4870
Project Description: Install 40 AMP shut off switch.
Owner Applicant Contractor
THOMAS GORHAM THOMAS GORHAM OWNER IS CONTRACTOR
MARGARET GORHAM 200 SW 292ND ST
200 SW 292ND ST FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Electrical Work Valuation? 450 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Saturday, July 8, 2017
Permit Issued on Friday, July 8, 2016
I hereby certify that the abov information is correct and that the construction on the above described property and
the occupancy and th use ill be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: 9 - 8- /4
THIS CARD IS TO REMAIN ON-SITE
Construction Ins ection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 16-103281-00-EL Address: 200 SW 292ND ST
Project: THOMAS GORHAM FEDERAL WAY, WA 98023-3502
Scheduled inspections may be failed if this card is not on-site. PO 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 LIFER Ground(4295) ❑ Ditch cover(4030) 0 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) ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
❑ Final-Electrical(4055)
Approved
Date 7 z6_ (c
Rough Electrical Final Electrical ❑ Right of Way
❑ Approved ❑ Approved Approved
By Date By Date By Date
RECEDED ELECTRICAL
CITY OF
Federal Way hut_ 03 ZM6 PERMIT APPLICATION
CITY OF FEDERAL WAY _ o hJ �'i z I
CDS PERMIT NUMBER f 1
SUITE/UNIT/SPACE#
SITE ADDRESS: a h 5 w (9 4=4 5
/�� ( �, /go 3
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ Lf 5-0.0 o ) 1 �i 6 0 0 - g 0 to.oc ri A .
PROJECT NAME
(Tenant or Homeowner Last Name) &0' . fj,4 r
ev5 '' c y 0 4yr ,/ Ai kir c)T' 51-017c y
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER / c2,, 45 G- oma..b io (PDC) Say
MAILING ADDRESS E-MAIL
a 00 5w dia,9S1- Goa. „ Hno .co,..
CITY STATE ZIP FAX
UV 47 w >9 .7Boa3 ( )
NAME PRIMARY PHONE
w '( �
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 TN 00"-A 5 G DSL- -rv. (acs ) 3o/_ ( goo'
MAILING ADDRESS E-MAIL
c3 00 S G o a-PIA" f A‘d'ta D s .�..
CITY STATE ZIP FAX
i 94 dl-9G. •,-01/A/s, w 4 CJT pa 3, ( ) -
PROJECT CONTACT NAME
PRIMARY PHONE
Hoe-, A5 6- oil-i{4 (o?a) oy - g c( 0
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 Iaws 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 part
�ofthis application.
SIGNATURE:"C!li"L 541! ,,i OIeL7 DATE 7/8//
PRINT NAME: T(4 6-OR MAL,vk
PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
253-835-2607+ FAX 253-835-2609 + permitcenter cityotfecleralway.corn
Bulletin#160—April 14,2016 Page 1 of 1 k:AHandouts\Electrical Permit Application