14-102169City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253 835-2609 FIL�
Project Name: HEALTHPOINT
Project Address: 33431 13TH PL S
Project Description: Voice/data cabling.
.�. Electrical
Permit #: 14 -102169 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number. 768190 0070
Owne
ARRlican
Contractor
KC -PUBLIC HEALTH
TEKNON CORPORATION
TEKNON CORPORATION
500 4TH AVE
15443 NE 95TH ST
TEKNOC' 147NA (5/10/15)
SEATTLE, WA 98004
REDMOND WA 98052
15443 NE 95TH ST
REDMOND WA 98052
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional?....................... No
Service greater than 999 Amps? .............................No
Electrical Fbdures
Low Voltage - Other (Commercial 1
PERMIT EXPIRES Saturday, November 8, 2014
Permit Issued on Monday, May 12, 2014
1 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
el / and the C* of Federal Way.
Owner or agentsL Z zef. / -C _ Date: —5-- � 2 '-1,4
CITY OF `!� r ,
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
14 -102169 -00 -EL Address: 33431 13TH PL S
KC -PUBLIC HEALTH FEDERAL WAY, WA 98003-6357
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.
Final - Electrical (4055)
Pv ���� Approved
By G _ 1 Date M
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By I Date
UFER Ground (4295)
Ditch cover (4030)
0
Slab/Concrete Floor (4255)
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Pv ���� Approved
By G _ 1 Date M
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By I Date
Pool Bonding (4195)
Temporary Power (4275)Service
(4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Pv ���� Approved
By G _ 1 Date M
Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By I Date
L
CITY of ``
Federal Way
MAy 12 2014
ITY of
CFEpERp,�WAY
Cps
PERMIT NUMBER /// – L 0— a 6 1 !E /
ELECTRICAL
PERMIT APPLICATION
`,
SITE ADDRESS: 3.3 7 3 � / 3 T# Pl. S
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S TAX/ ARCEL # j
1(�%,�' 0- U6 �7�,'
CURRENT/PROPOSED USE
-7k
PROJECT NAME
t/G-1
(Tenant or Homeowner Last Name)
Y�GC
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER//L>l
CCY�i'✓T �U,�S�/G �-/L f� LT��
( ) -
MAILING ADDRESS
//j vc
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
ELECTRICAL
MAILING ADDRESS
/Y44 3 I(J(5— q fl� 5%
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LI'C'ENSE # _ EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
r /-Ic 74 T
CITY
STATE
ZIP
FAX
PROJECT CONTACT"'��,G
NAME
PRIMARY PHONE
(� Z 5 �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 1 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 's application.
i %
SIGNATURE: DATE 5/ ,8 //Z/
PRINT NAME: .1; C-AIRD "11K6W74� f -
Bulletin #160 – January 1. 2013 Page I of 2 k:AHandouts\Electrical Permit Application