16-104664 Electrical
City of Federal Way ,.
Community&Econ.Dev.Services Permit #: 16-104664-00-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: CHRISTOPHERSEN
Project Address: 5320 SW 316TH PL Parcel Number: 321020 0351
Project Description: Remove exhaust fan and install (2)recepticals.
Owner Applicant Contractor
NICHOLAS D CHRISTOPHERSEN NICHOLAS D CHRISTOPHERSEN OWNER IS CONTRACTOR
AMY CHRISTOPHERSEN 5320 SW 316TH PL
5320 SW 316TH PL FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Electrical Work Valuation? 200 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 2
PERMIT EXPIRES Tuesday, September 19, 2017
Permit Issued on Monday, September 19, 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.
Owner or agent: ` - Date:
p•L.0)
•
THIS CARD IS TO REMAIN ON-SITE
"TM OF''410'
_ . -,.� Construction Inspection Record _ '
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-104664-00-EL Address: 5320 SW 316TH PL
Project: NICHOLAS D CHRISTOPHERSEN FEDERAL WAY, WA 98023-2039
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
o Pool Bonding(4195) ❑ Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
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.- Date-7 C_
El Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
Ait1/4„...„.
RECEIVED ELECTRICAL
CITY OF '
Federal WaySEp 19 2016 PERMIT APPLICATION
CITY OF FEDERAL WAY
CDS PERMIT NUMBER ) b
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SUITE/UNIT/SPACE#
SITE ADDRESS: S 3 Z 5( _� /6 p/-
PROJECT
VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
S �' z -_ 0 Z 0 _ 0 .35 /
PROJECT NAME , l l . / 1)�� 5��
(Tenant or Homeowner Last Name) (,,,� '�jt5
PROJECT DESCRIPTION J' CCp7/eid
Detailed description of work to
be included on this permit only
NAME �i PRIMARY PHONE
PROPERTY OWNER 6 t pb�� t ' )7 - -615-75' (
MAILING ADDRESS E-MAIL
CHITTY STATE ZIP FAX
( )
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME / PRIMARY PHONE
APPLICANT 1,iIGA,4. �/�"� p _/<, ( X17.9 - 1S i
MAILING ADDRESS / ` E-MAIL (- 1
C/�,v l en/ ST' " V C.� ( ) FAX
N /J PRIMARY PHONE
PROJECT CONTACT r' //;j F) <,NE
l��I C, 7� /2e,/ /1 (? /p'o`i - Lj 75 c5 1
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:
7--"rte---,--'-/ DATE 9v,F=� 7/JPRINT NAME: JC�'►/ l ?c/C012-15(4,•1_
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application