10-104523 Elcctr t al
City of Federal Way
Community Development Services 4.; . ` Permit ; 10-104523-00-E L
P.O.Box 9718
Federal Way,WA 98063-9718
(Ph:(253)835-2607 FaxInspection Request Line: (253)835-3050
:(253)835-2609
Project Name: STATE FARM INSURANCE 219 37
Project Address: 1400 S 312TH ST SUITE 2 Parcel Number: 082104 9090
Project Description: Adding/altering(1)circuit for lighting retrofit
Owner Applicant Contractor
GROVE STREET LLC ENERGY MANAGEMENT SERVICES ENERGY MANAGEMENT SERVICES
11700 MUKILTEO SPEEDWAY (GENERAL) (ELECTRICAL)
MUKILTEO,WA 98275 34310 9TH AVE S SUITE 108 ENERGMS913B6(1/26/11)
FEDERAL WAY WA 98003 15008 35TH AVE W SUITE C
LYNNWOOD WA 98087
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Is Use Educational or Institutional? No Service greater than 999 Amps? No
v74,V „3 f lect of Fixture '
Circuits-Commercial ” 1
PERMIT EXPIRES Wednesday, October 26, 2011
Permit Issued on Tuesday,October 26 2010
I hereby certify that theabove information is co c and that the construction on the above described property and
the occupancy and the u will b." in accord e ith the laws, rules and regulations of the State of Washington
tr - City of Federal Way.
Owner or agent: ,i1/4_.•�� ���` r Date:
FINALED Li /4/,o
THIS CARD IS TO IN ON-SITE
CITY OF Construction Ins ction Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 10-104523-00-EL Address: 1400 S 312TH ST SUITE 2
Project: GROVE STREET LLC FEDERAL WAY, WA 98003
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) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding(4195) 0 Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055)
Approved
By Date //. /VP
El Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
if RECEIV!D
OCT 262010 / 0 / 045Z �
' sF FEDERAL W/PERMIT
Fe•era gay ��� SF MF CO ME SEL L DE EN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION I /
253-835-2607•FAX 253-835-2609
wwwcituoffederalwau.com
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SITE ADDRESS
1400 S.312th St.
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
Suite#2 O $ 2 / D g _ c7 O q0
NAME OF PROJECT
(Tenant or Homeowner Name) State Farm
❑BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION
Retrofiting to the existing lights / fe-- i, e>
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Rick Kelly (253)839-9560
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
1400 S. 312th St.
OWNER IS ALSO: o CONTRACTOR ❑ APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
Energy Management Services Inc. (425)741-3526
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
15008 35th Ave.W.#C, Lynnwood, WA 98087 (425)741-3521
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ENERGMS913B6 01 /26/2011 20-29-100254-00-BL
NAME PRIMARY PHONE. _.
APPLICANT Same as the Contractor (425)741-3526
MAILING ADDRESS,CITY,STATE,ZIP FAX
(425)741-3521
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and Dave Davis (425)_879-2795
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) Same as the Contractor (425)741-3521
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
Sang W. Nam (425)273-7300 ems@emsiwa.com
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more _<MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( ) -
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 of this application.
SIGNATURE: J ` 6---.-1,,...---
._.i DATE r0/2.e120 i
0PRINT NAME: (-'-1 G v,J LE---E
Bulletin#100—4/21/2009 Page 1 of 4 k:\Handouts\Permit Application