14-101253 •
•
'' • Electrical
Community 8
City of EFederalDev.Way Permit #: 14-101253-00-EL
con. Services
33325 8th Ave S
P.Iuto41
Federal Way,WA 98003 F `�
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: EVERGREEN EYE CARE CENTER
Project Address: 34719 6TH AVE S Parcel Number: 202104 9178
Project Description: Low voltage disconnect and reconnect of existing heat pump.Provide line voltage
disconnect for new heat pump.Install(2)T-Stats
Owner Applicant Contractor
JARSTAD FAMILY LLC AIR SYSTEMS ENGINEERING INC AIR SYSTEMS ENGINEERING INC
34719 6TH AVE S (GENERAL) (ELECTRICAL)
FEDERAL WAY WA 98003 3602 S PINE ST AIRSYEI009KS (5/10/14)
TACOMA WA 98409 3602 S PINE ST
TACOMA WA 98409
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 Fixtures
Low Voltage-Other(Commercial 1 Thermostat 2
PERMIT EXPIRES Monday, September 15, 2014
Permit Issued on Wednesday, March 19, 2014
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 Washington
�,^_ p
and the City of Federal Way.
Owner or agent 1/ Date: #40. 19 r Z
FINALED
•
.. THIS CARD IS TO MAIN ON-SITE
a '
"TY OF • Construction In ction Record ,
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 14-101253-00-EL Address: 34719 6TH AVE S
Project: JARSTAD FAMILY LLC FEDERAL WAY, WA 98003-8714
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) El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
o Pool Bonding(4195) 0 Temporary Power(4275) Service(4235)
Approved Approved Approved
By Date By Date By Date
O Feeders/Sub-panels(4045) ' Ei Rough Electrical(4225) 0Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
'
El Final-Electrical(4055)
Approved
By IMP? Date 1+124114
El Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
w It
-k ELECTRICAL
CITY OF ` /0 /
Federal Way PERMIT APPLICATION
RECEIVED
PERMIT NUMBER C4_ _ _ 1 0 I E-�� 00 MAR 19 2014
SITE ADDRESS: 34719 6th ave south CrfuelP` M�-WAY
CDS
PROJICT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
5'261' , 00 2 0 2 1 0 4 _ 1 9 7 8
PROJECT NAME Evergreen Eye Care Center
(Tenant or Homeowner Last Name)
Provide line voltage disconnect and reconnect for existing heat pump.
PROJECT DESCRIPTION Provide line voltage disconnect for new heat pump.
Detailed description of work to (2)t stats
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Jarstad Family LLC (attn Carol Otto) (206 ) 21 2- - ZI GZ
MAILING ADDRESS E-MAIL
34719 6th ave south
CITY STATE ZIP FAX
Federal Way WA 98003 ( ) -
NAME PRIMARY PHONE
Air Sytems Engineering Inc. (253 ) 7Z 14"."
MAILING ADDRESS E-MAIL
ELECTRICAL 3602 South Pine St
CONTRACTOR CITY STATE ZIP FAX
Tacoma WA 98409 ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ / 19-73-000006-00-BL
NAME PRIMARY PHONE
Brett Roebuck (For Air Systems Engineering) ( ) -
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT ( ) -
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.
k
SIGNATURE: DATE /141L61 19 7U I f
/
PRINT NAME: 5 r e-k R d e L%GK
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application