17-102457 CITY OF -446..... .
ELEC'T'RICAL
Federal Way RECEIVED PERMIT APPLICATION
MAY 2 3 2017 / J
CITY OF FEDERAL WAY PERMIT NUMBER / 7 _
l O S •�--_
COMMUNITY DEVELOPMENT G — — — —
SITE ADDRESS' * SUITE/UNIT/SPACE#
62 7 5 .-31 P ( �
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
S , 1�,0 _ -
PROJECT NAME n
(Tenant or Homeowner Last Name) 12$iken_ T
ik tAGeleer ,,cn,( P-Qt cl tL'/ / flrIP
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE/
PROPERTY OWNER \6y> q R 1 (. �,;i<e) (.aidC) s / 7 c iF/Q
MAILING ADDRESS E-MAIL
`6017 S 31ci' PL
CITY STATE ZIP FAX
1'4'1246411 'suy ,A. `/ '? ( )
NAME PRIMARY PHONE
•
Pflrj ti5.. ,,.�C , 2t1 CSS ( ) Sq-
MAILING ADDRESS E-MAIL
ELECTRICAL l `ECS AL 133 " r L, vt1 .t9i'ririies ►,.('
CONTRACTOR 'C STATE ZIP F
zitt
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
'-A Ai 5oi. 3 `;vf 4 4/ ,/o /2f8
NAME �y PRIMARY PHONE
APPLICANT R i 4 "N-(SJ,J t� L ( ?(-t) f/6'- ' r.,.,
MAILING ADDRESS E-MAIL
664o /4 6 (330P ( , 41‘51,70,1,,gN4(e Aiiy,
��( ��� STATE ZIP FAX
� �4 96°
3 V ( )
PROJECT CONTACT NAME PRIMARY PHONE
(
M t ti _ A 1-len... p f -,e .49-_)r (46X-) _ - ‘7k-
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 Iaws.
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 arty 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 supplie to the city as a pa of this application.
SIGNATURE: , DATE , .? / /
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PRINT NAME: !�'e0 S. [-' (1 7 O,
Bulletin#160—April 14.2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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Electrical
ComFederal Way
of
Permit #:17-102457-00-EL
City33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: RIVERA
Project Address: 827 S 319TH PL Parcel Number:609400 0240
Project Description: Replace 125-amp panel.
Owner Applicant Contractor
JOSE RIVERA HANSON LIGHTING SERVICES LLC HANSON LIGHTING SERVICES LLC
827 S 319TH PL 10640 NE 133RD PL HANSOLS906JA(4/1/18)
FEDERAL WAY WA 98003 KIRKLAND WA 98034
10640 NE 133RD PL
KIRKLAND WA 98034
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Alt.Serv./Feeder:0 to 200 am] I
PERMIT EXPIRES Wednesday,23 May,2018
Permit Issued on Tuesday,May 23,2017
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 be in accordance with the laws, rules and regulations of the State of
ashington and the City of Federal Way.
Owner or agent: Date: - 2 3 ` ,,sof 7
THIS CARD IS TO REMAIN ON-SITE +
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Federal Vita Construction Inspection Record
Y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 102457 00 Address: 827 S 319TH PL
Project: JOSE RIVERA FEDERAL WAY WA 98003-5337
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) ,'• ,
El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
,BY Date By Date By Date
•' I
® Pool Bonding(4195) El Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date „
Q Feeders/Sub-panels(4045) ® Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
By eivii., Date bp-i- i t-I
El Rough Electrical El Final ElectricalD Right of Way
Approved Approved Approved
By Date By Date By Date