16-103410 CITY OF . ELECTRICAL
Federal Way RECEIVED PERMIT APPLICATION
J U L 2016 PERMIT NUMBER / t< _ ( c IS Li i 0 _ E
CITY OF FEDERAL WAY
CDS SUITE/UNIT/SPACE#
SITE ADDRESS: 7 U t J 10 anre s FS -,/ G' ov
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 7 . . 0 0 ,-( 7 7- 3 v C _ 0 cp -2_ 0
PROJECT NAME
(Tenant or Homeowner Last Name) IZ iv5a e_e,),.coce
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gfr_yy)i'74t77C ,q
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ;e400S/w 411y5r ') (2 j-3 )7gq - 2 Z 5-61
MAILING ADDRESS E-MAIL
•
3332 2 11/2,u/q&e 5W raolkltsr)ed,/TO//.t iy�
CITY STATE ZIP FAX
F / boy L&II7 91023 ( ) -
NAME PRIMARY PHONE
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 lin ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) _
PROJECT CONTACT NAME PRIMARY PHONE
iats lav (fem ( 7)-) 7,r - z
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 the city as a part of this application.
SIGNATURE: 6 2R/ DATE 7-/)---/C
PRINT NAME: /Za /f f/c / Z- /,J �J
Bulletin 4 160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
r El'ectrcal
City of Fco Way Permit #: 16-103410-00-E L
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 0335-2609
Ph:(253)835-2607 Fax (25398)08Inspection Request Line: (253)835-3050
Project Name: KRYSA
Project Address: 28811 19TH AVE S Parcel Number: 422300 0020
Project Description: NEW RESIDENCE,200 AMP SERVICE
Owner Applicant Contractor
RADISLAV KRYSA RADISLAV KRYSA OWNER IS CONTRACTOR
33322 42ND AVE SW 33322 42ND AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit information
Electrical Work Valuation? 7500 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
No Fixtures Associated With This Permit!!
PERMIT EXPIRES Saturday, July 15, 2017
Permit Issued on Friday,July 15, 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
and the City of Federal Way.
Owner or agent (D-4l/ j��e► Date: _l l
THIS CARD IS TO REMAIN ON-SATE r %*"
411Att• .
cord '
Federal Way INSPECTION REQUE Inspectionnstrction : (253)85-30500
PERMIT#: 16-103410-00-EL Address: 28811 19TH AVE S
Project: RADISLAV KRYSA FEDERAL WAY, WA 98003-3811
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) 0 Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By c } Date ,,L_i L By Date
o Pool Bonding(4195) ❑ Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By 64 Date 12-12-1 I r.
.
O Feeders/Sub-panels(4045) Q Rough Electrical(4225) ‘ ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By C, . Date 1 g-...Z Z_l 4::,,,, By Date
.0 Final-Electrical(4055)
Approved
�By Date& 0____(
O Rough ElectricalEl Final Electrical 10 Right of Way
Approved Approved Approved.
By Date By Date By Date