17-105256 Electrical
City of Federal Way Permit #:17-105256-00-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: BETHEL CHRISTIAN CENTER
Project Address: 129 SW MIRROR LAKE PARK Parcel Number:072104 9003
Project Description: Upgrade electrical panel.Moving existing wiring from old to new box.
Owner Applicant Contractor
BETHEL CHRISTIAN CENTER BETHEL CHRISTIAN CENTER OWNER IS CONTRACTOR
414 SW 312TH PL 414 SW 312TH PL
FEDERAL WAY WA 98023-4818 FEDERAL WAY WA 98023-4818
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Alt.Srvc/Feeder 0 to 200 ami 1
PERMIT EXPIRES Wednesday,31 October,2018
Permit Issued on Tuesday,October 31,2017
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy an. the use will be in accordance with the laws, rules and regulations of the State of
Washin n and the City of Federal Way.
Owner or agent: ' a44)6l Date: /0 l 3//1 7
THIS CARD IS TO REMAIN ON-SITE.
404 VI/ay Construction Inspection Record
INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 105256 00 Address: 129 SW MIRROR LAKE PARK
Project: BETHEL CHRISTIAN CENTER FEDERAL WAY WA 98023
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) f 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
® Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By iiii Date -...
7❑ Feeders/Sub-panels(4045) ® Rough Electrical(4225) 9❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
E l Final-Electrical(4055)
Approved
By indvi,r Date t t.al"\'-
O Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
ELECTRICAL
CITY OF
Federal Way PERMIT APPIaleATION
PERMIT NUMBER _ _ OCT 2017
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
SUITE/UNIT/SPACE#
SITE ADDRESS: I a 9 Yn c`krlro r L-
PROJECT VAL�TI�ONo� ASSESSOR'STAX/PARCEL# � � _ � � � � CURRENT/PROPOSED USE
PROJECT NAME e-i-h e!
(Tenant or Homeowner Last Name)
UP rc,. _ I����,�c.0 l /&(v- (
PROJECT DESCRIPTION +'nc4 v,\/-)q Cu N'✓'' y 4k)✓v- C [I + N e-W B&c
Detailed description of work to J
be included on this permit only
NAME �J PRIMARY PHONE
PROPERTY OWNER Se+i-lLI C L ✓ic-J-►4 ( ,,4e- 0 f-R w . (-2,5: )839- 2 q
MAILING ADDRESS) -_ E-MAIL
�y SiS. , 31 i be1►JJ ilerAN'Cas4Akt-
CITY STATE ZIP FAX
I ek 1 keL y W& 9 go 2_3 ( s39 )o 3 )
NAME PRIMARY PHONE
)
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY uu p TATE ZIP FAX
)
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( )
Aim i i.ri ��' E-MAIL
CITY STATE ZIP FAX
r )
NAME PRIMARY PHONE
PROJECT CONTACT D e [S ( ` .54- n (0253) SA-
32gt
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 th ty as a part of this application.
SIGNATURE: 1 C 1 DATE �� 131 /1 7
PRINT NAME: Deli(/1 v c S C_ i A LST
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application