17-102435 .\\
ELECTRICAL
CITY OFA
Federal Way PERMIT APPLICATION
PERMIT NUMBER 1 7 _ ) 0 2 Cf 3 ,. _ G. c.
CV SUITE/UNIT/SPACE#
SITE ADDRESS: 53 )off a,1 ikVE S'LJ
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME
(Tenant or Homeowner Last Name) Emu. SEc A eQio C2
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAMEP IMARY PHONE
PROPERTY OWNER F z€f) ►�f,e.yCC 1 k52-(06- # IN (d5 ) J,),- 0io0
MAILING ADDRESS E-MAIL
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CITY STATE ZIP FAX
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NAME PRIMARY PHONE
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MAILING ADDRESS E-MAIL
ELECTRICAL ,j.3J S PL S
CONTRACTOR CITY STATE ZIP FAX
S EXrnte 04 ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE . FEDERAL WAY BUSINESS LICENSE#
NAME r PRIMARY PHONE
APPLICANT y`��1`��� 0 ( )
MAILING ADDRESS E-MAIL
6530 S PL- 5
CITY STA E ZIP FAX
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PROJECT CONTACT NAME PRIMARY PHONE
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 art of this application.
SIGNATURE: �\\ DATE l
Al-NN) \
PRINT NAME: ALIV )
Bulletin#160—April 14,2016 Page 1 of 1 k:AHandouts\Electrical Permit Application
Electrical
City of Federal Way Permit #:17-102435-00-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: FRED MEYER GASOLINE FACILITY
Project Address: 33702 21ST AVE SW Parcel Number:930100 0010
Project Description: Replace old card ready with new secure card reader.
Owner Applicant Contractor
FRED MEYER INC MASCOTT EQUIPMENT CO INC MASCOTT EQUIPMENT CO INC
PO BOX 42121 435 NE HANCOCK ST (ELECTRICAL)
PORTLAND OR 97242 PORTLAND OR 97212 MASCOEC957C8(6/5/19)
435 NE HANCOCK ST
PORTLAND OR 97212
Additional Permit Information
Is this an Online or O.T.C.application? Yes
-,..•��.�. .�If§ „ Ku�,... "�� .sr;u flItlf°€; 6 k a •F 5 °�¢s� �. A ' EN�k �`E� , �is'm ,Y3
PERMIT EXPIRES Tuesday,22 May,2018
Permit Issued on Monday,May 22,2017
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and th- use will •- in accordance with the laws, rules and regulations of the State of
Was gton and the City of Federal Way.
Owner or agent: I 'N.. . \ Date: S `c�..0. .l---)
\
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 102435 00 Address: 33702 21ST AVE SW
Project: FRED MEYER INC FEDERAL WAY WA 98023-7762
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 UFER Ground(4295) Ditch cover(4030) ® Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date ..By Date
•40
® Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
7❑ Feeders/Sub-panels(4045) ® Rough Electrical(4225) e❑ Ceiling Cover(4020)
Approved Approved Approved
By Date ��By Date ,.By Date
El Final-Electrical(4055)
Approved
BKI' Date -c- 2t- 1
0 Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date