17-103928 -
Electrical
City of Federal Way Permit #:17-103928-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: ACCURATE CHIROPRACTIC
Project Address: 34512 16TH AVE S Parcel Number:250090 0050
Project Description: Relocation of thermostat.
Owner Applicant Contractor
FEDWAY MARKETPLACE WEST LLC(C/O AIDAN WILSONUNIVERSAL UNIVERSAL REFRIGERATION INC
MJ KLEIN) REFRIGERATION (ELECTRICAL)
30300 AGOURA RD SUITE 270 4102 B PL NW UNIVERI000BO(1/20/18)
AGOURA HILLS CA 91301 AUBURN WA 98001 PO BOX 614
AUBURN WA 98071-0614
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Thermostat l
PERMIT EXPIRES Wednesday, 15 August,2018
Permit Issued on Tuesday,August 15,2017
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
Was.' gton and the City of Federal Way.
Owner or agent: 411111. nn/' Date: .?��� S�
THIS CARD IS TO REMAIN ON-SITE
. 4.
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 103928 00 Address: 34512 16TH AVE S Unit C
Project: FEDWAY MARKETPLACE WEST L 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.
® UFER Ground(4295) El Ditch cover(4030) 3❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
r
By Date 1.By Date By Date
® Pool Bonding(4195) ® Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
'ID Feeders/Sub-panels(4045) •�® •'
Rough Electrical(4225) 0 Ceiling Cover(4020) '
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
By Gtr.. Date A 3_T,,n
Rough Electrical Final Electrical U Right of Way
Approved Approved Approved
By Date By Date By Date
/'
/ RECEIVED
on OF ` AUG 15 2017 ELECTRICAL
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
COMMUNITY DEVELOPMENT
PERMIT NUKBSR 19-_ .40____E_ el �k. _ a L
'I
SUITE/UNIT/SPACE# ,
SITE ADDRESS: 4512 tu� Ksj . SOtl ►
PROJECT VALUATION �t ASSESSOR'S TAX/PARCEL S CURRENT/PROPOSED USE
$ 1z1 . °9- 2 S o a I o - o 0 5 p
PROJECT NAMEI
(Tenant or Homeowner Last Name) 1 C.I.l. 1ZP H all a-D.?(LA C. . 2 t Z .
`WtlolrA\-t;: LX15N Ztbrz /los-r.V ovisota ,DoRt1
PROJECT DESCRIPTION S i to
11 C, n1S4rLk)C.r'0 • tow VC)tk-A t (S112.I13
Detailed description of work to
be included on this permit only
NAME ( PRIMARY PHONE
PROPERTY OWNER �b� sPlt AktaZ.E LCL- L L4. I..LC. (Z53 )T74 - (al
MAILING ADDRESS > E,MAIL
CITY STATE ZIP FAX
( )
NAME ,C/k/vev5 ? t�1e ,�< io.t (ZS3) 9 �/
MAILING ADDRESS / _
ELECTRICAL WC)2 l�(qC� e /er 1
CONTRACTOR clTsr STATE /_FAX
(ZS i7)
�ro�-w-v� WWF 'MOO/ 3Y52-
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
I1N/1/Xi'/ Q / / za//V ,7-? -/o7077-0)- L
NAME
5a�n q5 ,/O se-e._- Pyr-PHONE
APPLICANT _--- G- p (' 4 )�3#I-S�D�
MAILING ADDRESS Y 1l E-MAIL
itePAL mel/7iYei /i ^�t i .
CITY ' STATE ZIP FAX CO1�l
(255)?SYHONE��
NAME ' PHONE
PROJECT CONTACT fcA Af �a (Z )939 - --S?)/'
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.
C
SIGNATURE: _ / t DATE o c/ `
i
PRINT NAME: \I r L• / CSG-%j/��'l� /// JJ
Bulletin#160-January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application