17-102223 Electrical
City of Federal Way Permit #:17-102223-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609
Project Name: AVALON CARE CENTER
Project Address: 135 S 336TH ST Parcel Number: 926504 0110
Project Description: Replace nurse call devices; replace controller,annunciators in (2)locations,replace low-voltage
24-v devices.
Owner Applicant Contractor
AVALON CARE CENTER FEDERAL WAY JAMES GOLLNER JAMES GOLLNER
LLC 25576 GOLDENSPRING DR JAMESG893BK1/25/18
135 S 336TH ST DANA POINT CA 92629 JAMESG893BK(
)
25576 GOLDENSPRING DR
FEDERAL WAY UT 98003-6601
USA DANA POINT CA 92629
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Electrical Fixtures
Low Voltage-Other(Commei 1
PERMIT EXPIRES Saturday, 12 May,2018
Permit Issued on Friday,May 12,2017
I hereby certify that the above.information is correct and that the construction on the above described property
and the occupancy and;11 use will be in accordance with the laws, rules and regulations of the State of
Washington and the City of Federal Way.
Owner or agent: Date: '---;(//Z//
s
446_._., THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 17 102223 00 Address: 135 S 336TH ST
Project: AVALON CARE CENTER FEDERAI FEDERAL WAY WA 98003-6601
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) El Ditch cover(4030) C Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 0 Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
,
0 Feeders/Sub-panels(4045) El Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
".
By,: `._ _, Date 0------7.- ".
El Rough Electrical ❑ Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
,iii*„.
CITY OF RECEIVE ELECTRICAL
Federal Way MAY 12 201 PERMIT APPLICATION
1
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT PERMIT NUMBER / 7_ / eid_ 3 ..? -
SUITE/UNIT/SPACE#
SITE ADDRESS: i 3 5 Ou I-1 3(,,I-11 , r
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name) Vv 0G, / 6 1, Ca Ye C p -eA
RF-PLA Cr Nw✓1(iiic CAA t DE\, ic_Es
PROJECT DESCRIPTION R.i�<NIA C t` L(oA'i R C) I t Iii , A?UN umC,i AT O R S I.&) '. L O GiTi 0%
Detailed description of work to R E Pt Ac:IL L DW do LTA(s
be included on this permit only L" 2 v �' -K s
NAME PRIMARY PHONE
PROPERTY OWNER kV h L 0k) CAQt r;,F=/v; R, Pe t,_nc lA)A (C )(D07
MAILING ADDRESS 7
E-MAIL
135 pc,ci i-4 32)(D 11-k ST RE r ,.(noiIA)Eike c.a.I>,)g7'
CITY STATE ZIP FAX
i V-bw2\L 1A)I t" CI003 ( ) -
NAME
PRIMARY PHONE
JA/,1r.5litir2 (99 ) (407= 782.
MAILING ADDRESS E-MAIL
ELECTRICAL a•G57L. (>=t.i�j- SPPR1A p42.
CONTRACTOR CITY STATE ZIP
FAX
r)A i PoIA; LA qL 2,1 ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME
PRIMARY PHONE
APPLICANT ZAmii.� Com,1i,J;F.1 (`?Nq1 ) (007- 7L ??,2
MAILING ADDRESS E-MAIL
h5 c> e;DLIY-N) Sy(a I,N' ik -.(90/14)1i2 C-uox . Am t
CITY STATEZIP
DIA
D 4 9(9 1 A ( ) -
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 o such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claispt a 'ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to e c'y
as a part of this application.
SIGNATURE: ..'•
7 DATE i /I'Z C 7
PRINT N E: 4 f' / /(.-
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application