16-100834 Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 16-100834-00-EL
33325 8th Ave S
- Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: NASH
Project Address: 30623 28TH AVE S Parcel Number: 092104 9195
Project Description: Relocate 200-amp panel and wire addition.
Owner Applicant Contractor
MICHAEL&ROBIN NASH A&I ELECTRICAL REPAIR INC A&I ELECTRICAL REPAIR INC
30623 28TH AVE S 12534 SE 16TH ST IELECRI954BR(2/13/17)
FEDERAL WAY WA 98003 BELLEVUE WA 98005 12534 SE 16TH ST
BELLEVUE WA 98005
- Additional Pmt Information
Electrical Work Valuation? 4500 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
Electrical Fixtures
Alt. Serv./Feeder: 0 to 200 amps(F 1
PERMIT EXPIRES Wednesday, February 15, 2017
Permit Issued on Tuesday, February 16, 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.
AO.Owner or agent: , cam Date: 2
•
THIS CARD IS TO REMAIN ON-SITE
CITY°F " Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-100834-00-EL Address: 30623 28TH AVE S
Project: MICHAEL & ROBIN NASH FEDERAL WAY, WA 98003-4803
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) El Ditch cover(4030) Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
[1: Pool Bonding(4195) 0 Temporary Power(4275) E3 Service(4235)
Approved Approved Approved
By Date By Date ---;;----- Date Fe /�Y,
eders/Sub-panels(4045) ElRough Electrical(4225) 'El Ceiling Cover(4020)
Approved Approved Approved
By Date B Date By(TS Date
El Final-Electrical(4055)
Approved
By Q_AAL, Date cs _44,4 b
ED Rough Electrical ■ Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
AIL FEB 16 2016 ELECTRICAL
CITY OF
Federal Way CI Y OF CDDSRALWAY PERMIT APPLICATION
•
PERMIT NUMBER /0 / 0 0 Re- 3 3
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 OK-23 2 7-,41
PROJECT VALUATION �,�) ASSESSOR'S TAX/PARCEL# ,� CURRENT/PROPOSED USE
(.(500 Q �- ( C2 (II' - S
PROJECT NAME
(Tenant or Homeowner Last Name) A-S ft
2120 . P�—
PROJECT DESCRIPTION / g U S /r ter- 7 4 v / /T"C',v
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER A,(/ Ci''A-iF L 2 j IV A S /I ( ) -
MAILING ADDRESS E-MAIL
7oK23 2� 7-4/ X(21/-=------ S
CITY STATE ZIP FAX
�� C � � w ��D� � ( ) -
NAME PRIMARY PHONE
„Ll F«(7 , '( p2TO‘0i, /LJC. (20 )2.0f gee
MAILING ADDRESS E-MAIL
ELECTRICAL '( 9/- (6. 7
4` S
CONTRACTOR CITY STATE ZIP FAX
• CC, I/vE (!J/1 ��dd & ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
COVir/QC7-4
NAME PRIMARY PHONE
APPLICANT /46/(7;74— F(2,6 (2a' ) 2-z t �7' S`.
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
N PRIMARY PHONE
PROJECT CONTACT ( )
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 arise out of the relian • of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci as a part of this a •1 ation.
SIGNATURE: /1/`dIL • DATE 2
PRINT NAME: 16�/
(TC
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application