16-101930 Electrical
unity&FederalnWay Permit #: 16-101936-00-EL
Community&Econ.Dev.Services
33325 8th Ave S _
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: NORTHWEST CHURCH
Project Address: 34800 21ST AVE SW Parcel Number: 542350 0630
Project Description: Replace fixture with four can lights and connect bathroom fan
Owner _ Applicant Contractor
NORTHWEST CHURCH NORTHWEST CHURCH OWNER IS CONTRACTOR
.. 34800 21ST.AVE SW , 34800 21ST AVE SW PAULCE214M6
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 PAUL,CERTIFIED ELECTRICIAN
FEDERAL WAY WA
Additional Permit Information
Electrical Work Valuation? 300 -. _ Isthis an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No Service greater than 999 Amps? No
No Fixtures Associated With This Permit!!
PERMIT EXPIRES Friday, April 21, 2017
Permit Issued on Thursday, April 21, 2016
•
I hereby certify that the abov • •rmation is correct and that t•e c. struction on the above described property and
the occupancy and the us=will be in •rdance with the la , r es -nd regulations of the State of Washington
-•d th= i if F-• -r.,/W., .
Owner or agent - �� Date: — 2 r —
Cil'
4fi
r?.
0 THIS CARD IS TO MAIN ON-SITE
CITY OF Construction In ection Recor
Ferrera! Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 16-101930-00-EL Address: 34800 21ST AVE SW
Project: NORTHWEST CHURCH FEDERAL WAY, WA 98023-3044
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.
0 UFER Ground(4295) 0 Ditch cover(4030) Q Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding(4195) '0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By IA_ Date `1 .._1)...
By Date `'i 2$-1
❑ Final-Electrical(4055)
Approved
B S Date 5—_ ,<---,:,(1,::,
. .
rBiRough ElectricalFinal ElectricalRight of Way
Approved Approved Approved
Date By Date By Date
. A
41110IvED EL%CTRI CAL
CITY OF
Federal Way APR 21 2016 PERMIT APPLICATION
arY OF FepERP,L WAS `, ] /�
CSS r
PERMIT NUMBER 1 V - / U / , 3 0_ l✓
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 1.4 g JQ L
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 3 0 0 3 5 o - b 6 3 0 i✓r1 X17'
PROJECT NAME
(Tenant or Homeowner Last Name) y,,��``�CX W ir6''s
PROJECT DESCRIPTION �" a-��Q- cvv..
Detailed description of work to
be included on this permit only
NAME '1,- PRIMARY PHONE
PROPERTY OWNER N�o1 w e>t rc (2-,63) 333 - 3 Z
MAILING ADDRESS ,1.. E-MAIL
tko, ICS
CITY STATE ZIP FAX
Wu-Ai t,j A t/�0 2.3 (as3 ) S53K - 720g
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
A GANuX\u._eerk wt b (LNI)
NAME PRIMARY PHONE
1AQ4,k Gln✓rcL ( 263 ) 38 - 0321
APPLICANT MAILING ADDRESS E-MAIL
34-t c 21 s.' AOC-- S &LAC stb�.�, �r 410.1-4..4a
CITY STATE ZIP FAX
c�cu Wca-0L l,O 1k 'j V.)43 (Zs3 ) `d 3 5 - 73'0Y
NAME PRIMARY PHONE
PROJECT CONTACT A,3Fo'J (4s3 ) (0'77- /.Z Z 3
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 t • • •- •. •art of this ap ication.
SIGNATURE: - DATE / Z/ -f
PRINT NAME: V e31-uCt.A.
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application