17-105699 ar icta
City of Federal Way Permit #:17-105699Eie-00t -ELl
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: JACK IN THE BOX
Project Address: 31130 PACIFIC HWY S Parcel Number:785360 0186
Project Description: Install J-Box and route existing conduits into J-Box above the ceiling grid.
Owner Applicant Contractor
JACK IN THE BOX JOE ELSHQLZJ W ELECTRIC J W ELECTRIC
9330 BALBOA AVE 9625 DEKOVEN DR SW JWELEE*934JW(4/27/19)
SAN DIEGO CA 92123 LAKEWOOD WA 98,499
9625 DEKOVEN DR SW
LAKEWOOD WA 98499
Additional Permit Information
Is this an Online or O.T.C.application? Yes
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PERMIT EXPIRES Wednesday,28 November,2018
Permit Issued on Tuesday,November 28,2017
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
C Washington and the City of Federal Way.
Owner or agent: `� Date: I f- o� r r 17
liltTHISCARD IS TO REMAIN ON-SITE
Federal , Construction Inspection Record `
INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 105699 00 Address: 31130 PACIFIC HWY S
Project: JACK IN THE BOX FEDERAL WAY WA 98003-4905
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.
0 UFER Ground(4295) 0 Ditch cover(4030) El 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
El Feeders/Sub-panels(4045) ® Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date I I mo'1i By Date
El Final-Electrical(4055)
Approved
By Vii Date t(12.4 111
0 Rough Electrical Final Electrical 0 Right of Way
Approved Approved Approved
By Date - By Date By Date
(/ RECEIVED
CITY OF NOV��� 2 8 2017
ELECTRICAL
Federal Way ;I OE rEDt RAL WAY PERMIT APPLICATION
COMMUNITY DEVELOPMENT
PERMIT NUMBER 111 _ 1 0 5 Co 1
-
SUITE/UNIT/SPACE#
SITE ADDRESS: 2 H 3 o R <.1,� 4W/ S
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ soo 1 8 5 3 c0 0 _ o 1 8 L
PROJECT NAME
(Tenant or Homeowner Last Name) 3 11 0 9aG1
,`' t C. P../ j S
^S ?vi , a-^ E07r C' J {e`w
PROJECT DESCRIPTION � . �S ' � a ,�
Detailed description of work to
i S ,t r .3 C.,,.� ,,,,
be included on this permit only J
a 1,..A-
NAME
� ' � r"S4-, Ce, �Ir r^,4 .
NAME PRIMARY PHONE
PROPERTY OWNER ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME - PRIMARY PHONE
3- w I-« br,n�. (?rS) ‘ci- Ori-
MAILING ADDRESS E-MAI
ELECTRICAL `I' c�` `� ('�c k c'✓w p - ,0e e 3--,,..)e )ce. , i .t-c1"
CONTRACTOR CITYSTATE ZIP FAX
L�,k�w VvH 181 / ( ( ) _
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 at c- L f Pj 07- ( ) -
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.
SIGNATURE: _ DATE
09—
PRINT NAME:
.o-o-c- t% i J 1-J1--
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application