17-104080 ,
, •
Electrical
City of Federal Way Permit #:17-104080-00-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: FORTENBERRY
Project Address: 33056 44TH AVE S Parcel Number: 152104 9154
Project Description: Install new service and wiring for associated single family residence addition
Owner Applicant Contractor
BRETT W FORTENBERRY BRETT W FORTENBERRY OWNER IS CONTRACTOR
33050 44TH AVE S 33050 44TH AVE S
FEDERAL WAY,WA 98001 FEDERAL WAY,WA 98001
Additional Permit Information
Is this an Online or O.T.C.applications Yes
Alt. Serv./Feeder:0 to 200 atm 1 Mast or Meter Repair(Resider 1
PERMIT EXPIRES Thursday,23 August,2018
Permit Issued on Wednesday,August 23,2017
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
,F Washington and the City of Federal Way.
Owner or agent: "`—L- Date:
'Z/ z3 1 -1
FINALED
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THIS CARD IS TO REMAIN ON-SITE
•
CITY OF
Construction
Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 17 104080 00 Address: 33056 44TH AVE S
Project: ANIKA M FORTENBERRY FEDERAL WAY WA 98001
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) ® Ditch cover(4030) ® Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By (-1-.1C�j Date oz, _ \ r_i r\ By Date By Date
® Pool Bonding(4195) ® Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By ,. Date
O Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By 1Date By C \,, ...,....\ Date \ _t —17 By Date
i
El' Final-Electrical(4055)
Approved
By ' 4# Date
Rough Electrical ❑ Final Electrical111Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF ELECTRICAL
Federal Way PERMIT APPLICATION
RECEIVED
PERMIT NUMBER t - I 0 4 0 SC: 0 C,
AUG 232017
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SITE ADDRESS: 3 3 Q5.b y�\ V` p O ' ���,'i' 1 y� pMENT
PROJECT VALUATION ASSESSOR'S T z.. L# 04 ( ( �/ CURRENT/PROPOSED USE
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PROJECT NAME j' l
(Tenant or Homeowner Last Name) Y uQ �'f 1! Vh
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PROJECT DESCRIPTION V� { u ` u( s
Detailed description of work to �. 15 J .� 3 b
be included on this permit only i \� , Yv—
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NAME \ PRIMARY PHONE
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E-MAIL
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CITY STATE ZIP FAX
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NAME O W PRIMARY PHONE
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MAILING ADDRESS E-MAIL
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CONTRACTOR CITY \ STATE ZIP FAX
C ti i h •11(k.i WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAMEr ' , PRIMARY PHONE
APPLICANT 4,,v ( ) , ,
MAILING ADDRESS E-MAIL
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CITY STATE ZIP FAX
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NAME ` PRIMARY PHONE
PROJECT CONTACT 1 I' ( ) E
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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.
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SIGNATURE: ( _ DATE 7C 1 1
PRINT NAME:
Bulletin#160—January 1,2013 Page 1 of 2 k:Ilandouts\Electrical Permit Application