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17-105059 Electrical City of Federal Way Permit #:17-105059-00-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: NIELSEN Project Address: 141 SW 374TH ST Parcel Number:218820 4045 Project Description: Mast Replacement Owner Applicant Contractor HUGH NIELSEN HUGH NIELSEN OWNER IS CONTRACTOR 141 SW 374TH ST 141 SW 374TH ST FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 Additional Permit Information Is this an Online or O.T.C.application? Yes Mast or Meter Repair(Resider. 1 PERMIT EXPIRES Friday,19 October,2018 Permit Issued on Thursday,October 19,2017 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 Washingto and the City of Federal Way. Owner or agent: � T- J Date: /1 c- 4444A, .- — , THIS CARD IS TO REMAIN ON-SITE • Federal Wa Construction Inspection Record Y INSPECTION REQUESTS:(253)835-3050 PERMIT#: 17 105059 00 Address: 141 SW 374TH ST Project: HUGH NIELSEN FEDERAL WAY WA 98023-7317 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) 2❑ Ditch cover(4030) 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 Date ID Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020) Approved Approved Approved . . 1.•� By Date ".By Date ; By Date 4 El Final-Electrical(4055) Approved � � Date( f") 0 Rough Electrical 0 Final Electrical Right of Way Approved Approved Approved By Date By Date By Date „YOF A. RECEIVED ELECTRICAL Federal Way oCI 19 2o17 PERMIT APPLICATION DV ON FEDD�ELQ MENT / /' cOMMUNf1`( PERMIT NUMBER / 2_ / D `7 05 C/ - T L SITE ADDRESS: SUITE/UNIT/SPACE# /i/ 9w 5 / PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE $ #yo �� °� A 1 F 5 A a - V 0 , PROJECT NAME (Tenant or Homeowner Last Name) 1U t e./( /( s M HST �RF`P i9c,E/�IFNT 2'DRi,DG F_p X--I0 � PROJECT DESCRIPTION Dipof work to be included etaileddescron thtionis permit only NAME M PRIMARY PHONE PROPERTY OWNER HUG/” /1 IV/E'L5E/J (206 ) ego_o 7 7 MAILING ADDRESS E-MAIL /y/ Sry j7i 5/REC Ail ALOVEVE5f6eyft fn, CITY STATE ZIP FAX FEDERAL Wi?.y (// q'oz, ( ) - NAME PRIMARY PHONE i 0 me , OWNER ( ) - MAILING ADDRESS E-MAIL ELECTRICAL / p 5k/ 57'?Tll 57e LET CONTRACTOR CITY STATE ZIP FAX F F.4tRAz 144)/ W/3 98"0 2.5 ( ) - WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / NAME PRIMARY PHONE APPLICANT ( ) MAILING ADDRESS E-MAIL CITY STATE ZIP FAX ( ) - NAME PRIMARY PHONE PROJECT CONTACT 1)11G/I N/01-5FAk ( ) - 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 thiss application. SIGNATURE: 0 91410-40 DATE /0/1/240, PRINT NAME: Bulletin 4 160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application