16-104000 Electrical
City of&FEcon.
Way Permit #: 16-104000-00-E L.
Communitycon.on.Dev.Services
33325 8th Ave S
Ph:(253)
Federal 835-2607 Way,WFax:A(253)8 53) Inspection Request Line: (253) 835-3050
835-2609 p q
Project Name: MIRROR LAKE ELEMENTARY
Project Address: 625 S 314TH ST Parcel Number: 082104 9035
Project Description: Altering(5)circuits boiler connects and reconnects.
Owner Applicant Contractor
FEDERAL WAY PUBLIC SCHOOLS DIANA THOMPSON THOMPSON ELECTRICAL
33330 8TH AVE S THOMPSON ELECTRICAL CONSTRUCTORS CONSTRUCTORS INC
FEDERAL WAY WA 98003-5433 150 100TH ST S THOMPEC008CW(2/16/18)
TACOMA WA 98444 PO BOX 45260
TACOMA WA 98445
Additional Permit Information
Electrical Work Valuation? 10600 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? Yes Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial 5
PERMIT EXPIRES Wednesday, August 16, 2017
Permit Issued on Tuesday, August 16, 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 the laws, rules and regulations of the State of Washington
an. tie City off�Federal Way.
Owner or ages i
t a<70 ,, /g'1�t'L. Date: /r%
THIS CARD IS TO REMAIN ON-SITE
c,TM OF " Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-104000-00-EL Address: 625 S 314TH ST
Project: FEDERAL WAY PUBLIC SCHOOLS FEDERAL WAY, WA 98003-5214
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.
UFER Ground (4295) 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
Feeders/Sub-panels(4045) 0 Rough Electrical (4225) Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
Final-Electrical(4055)
Approved
By C � Date e o3N
Rough Electrical Final Electrical Right of Way
❑ Approved ElApproved I=1Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF AUG 16 2016
Federal WayPERMIT APPLICATION
CITY OF FEDERAL WAY /
CDS PERMIT NUMBER 1 _ 1 0 L/ Cr (:2 J , _ Cr-/ SUITE/UNIT/SPACE#
SITE ADDRESS: ��2� cJ�Gt /�( (�/ ,„ �-
Q��� IONQ AS ESSgS TAX/PARCEL# 0 `.� - /^,� CURRENT/PROPOSED USE
PROJECT NAME ^`"J� C v
(Tenant or Homeowner Last Name) c301k Pep k ,.co //K/ c/ Xa.L Eye,.
PROJECT DESCRIPTION a/A°r//?c'' .›r e//'L° i'7 cgp-i/e r' (7hS c'rc,o r e c.fS' -z.- c/}
Detailed description of work to r.t,s,0>r'il e c-1"-be included on this permit only -
NAME p PRIMARY PHONE
'j-e /
PROPERTY OWNER ierct( tc2 y &iA e/ iS/1 r/c f (253 ) 94-5-- 2L ) CD
MAILING ADDRESS J E-MAIL
333.30 2- Oce . E
CITY} /J/' �STAyTE ZIP
_. -E& a 13 L g-oo 3 ( ) FAX
NAME PRIMARY PHONE
40n ."00 E)ec:7r �r
. ,cAi 4s'fro c.1:ofS (253) `x-69-99
MAILING ADDRESS /çe J,,,l-1 E-MAIL
ELECTRICAL O • � ejLS 2(o CJ %�ic,royasc��, t cin 41'u c'fc.,is,c 011
CONTRACTOR CITY STATE ZIP FAX
/ di i10.r7-1a_ Gc.)11 ?ir` 8- ( 2 S3)S3 - o/o%
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
...rvPz_cooee io.: _ 2 iii peve Of-/0-2w/- ac373,1_,
NAME PRIMARY PHONE
/an ex-- /Lni ., (2S-3 ) 39-o999
APPLICANT MAILING ADDRESS E-MAIL
0 ( c 4260
CI STATE ZIP FAX
ad-6,--)-7e1_,- 14),'9' ?�'`{'f , ( ) -
N ` PRIMARY PHONE
PROJECT CONTACT -eil11 /AUiti9p �'l ( AR 5 7 2_.
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 t e city as a part of this a plication. (�� �/
SIGNATURE: �®%f Y(� 2� DATE a -/6 /CS / (p
PRINT NAME: isIIc`� 1 T'1 c�✓�'1�
PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
253-835-2607+ FAX 253-835-2609 + permitcenter@cityoffederalway.com
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application