17-102174 Electrical
City of Federal way Permit #:17-102174-00-EL
,, _ , W..
Community Development Deptii t
33325 8th Ave S
Federal Way,WA 98003 • Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: ST FRANCIS HOSPITAL-OBSERVATION UNIT
Project Address: 34515 9TH AVE S Parcel Number:750451 0020
Project Description: Installation of low-voltage data&CATV. Demo existing unused cable.
•
Owner Applicant Contractor
JOHN ELSWICKFRANCISCAN HEALTH INTRACOMMUNICATION NTWK SYS IN INTRACOMMUNICATION NTWK SYS IN
SYSTEM-W (INSI) (INSI)
1717 S"J"ST 4922 N PEARL ST INTRANS994JL(4/10/19)
TACOMA WA 98405 TACOMA WA 98407 4922 N PEARL ST
TACOMA WA 98407
Additional Permit Information
Is this an Online or O.T.C.application Yes
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PERMIT EXPIRES Thursday, 10 May,2018
Permit Issued on Wednesday,May 10,2017
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 .e in accordance with the laws,rules and regulations of the State of
shington and the City of Federal Way.
Owner oyagent: - �,�.-* Date: _s--/d / 7
R1Y ."..3
I s 'r—i--I
THIS CARD IS TO REMAIN ON-SITE
Federal Wa Construction Inspection Record
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 102174 00 Address: 34515 9TH AVE S
Project: JOHN ELSWICK FEDERAL WAY WA 98003-6761
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.
El LIFER Ground(4295) 0 Ditch cover(4030) EISlab/Concrete Floor(4255) '
Approved Approved Approved to place concrete
By Date • BY Date By Date
® Pool Bonding(4195) El Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date • By Date By Date
® Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By n sa.s, Date L.... ...t. ..0-1
CI Final-Electrical(4055)
Approved
By 0,,t11 Date rl —54.. 1'1
9 Rough Electrical 9 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
�►• ELECTRICAL
CITY OF r: ,. ., MAY 10 2017
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
COMMUNITY DEVELOPMENT
PERMIT NUMBER / - — / D / �^' _ EV
-4/ � 'J�� , SUITE/UNIT/SPACE#
SITE ADDRESS: 3 ys/f" (? "l,� "vac fEGe3 1-')/ 47 1
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ /g 067 `7J O `f ( - d 04-0
PROJECT NAME "7", `
(Tenant or Homeowner Last Name) ��S1, eW v" �
PROJECT DESCRIPTION ,e9r' C' 4.44/4/5-.722 �pcv 2,o/V,07,-c'®ad/ter.
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER �t'/�'•uC�IC�,c� r �/�L� ��5���y (2)3) '2,*- S-3 2 3
MAILING ADDRESS E-MAIL.
»r7 s $/
CITY STATE ZIP FAX
7;74e,41,-/- bf4."- 9.0 / ( ) -
NAME r PRIMARY PHONE
(253) %%1- efr`/P
MAILING ADDRESS E-MAIL
ELECTRICAL Y9R2 /t/11 Z 4 �/s7G � � , . /rsrs•e'r, 7
CONTRACTOR CITY STATE ZIP FAX
t- 9/ Vo 7 (25 3.)177- A6'e
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
7/2.V7/S 97 Y Y/ ozd-� _`ea dLI e L.
NAME PRIMARYPHONE
/ �, (2(r) 70._ o//I
APPLICANT MAILING ADORES E_
4/ 12Z. ./f/ /:t_A / S--7 Z /.‘,/z40,2>/•/Sre
CITY STATE ZIP AX
�/C Z 4 99/V '7 (2s3)g�`j- oljG
NAME PRIMARY PHONE
PROJECT CONTACT
� . y /241-2-5 /Z-� (75J) 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 to the city as a part o'this application.
SIGNATU' 400 DATE
PRINT NAME: � � /y�'Gt ii 601
Bulletin#160-January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application