17-105813 ,
'P 4
t �
Electrical
City of Federal Way Permit #:17-105813-00-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: CORNELL
Project Address: 1134 SW 296TH ST Parcel Number: 119600 4830
Project Description: Electrical permit to close out 16-102719-00 for full rewire and new 200amp service
Owner Applicant Contractor
JIM CORNWELLSLIPPAHS LLC JIM CORNWELLSLIPPAHS LLC OWNER IS CONTRACTOR
PO BOX 12828 PO BOX 12828
MILL CREEK WA 98082 MILL CREEK WA 98082
Additional Permit Information
Is this an Online or O.T.C.application') Yes
� � E✓��"''ft�rb��`�siv��l,:�l'�/s�bkf � €,': 5 a n E�fz� ifs u t�hr' � '�C€�S'�EN�E � � X ,� r" r r/y�� / ,�y�e y
ru : s i €Es S r�<.„ ��a E Z ✓��ar.� fEE €4€�I,?w€E��a,r,u-_
Alt.Serv./Feeder:0 to 200 am] 1 Circuits-Residential 16
PERMIT EXPIRES Wednesday,5 December,2018
Permit Issued on Tuesday,December 5,2017
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
Washington and the City of Federal Way.
Owner or agent: Date: /2 - S — 7
THIS CARD IS TO REMAIN ON-SITE , c,,, , .4
CRY OF Construction Inspection Record
Federal . • INSPECTION ESIIIE 'FTS:.(2553).835-305Q
PERMIT#: 16-102719-00-EL Address: 1134 SW 296TH ST
Project: JIM CORNWELL FEDERAL WAY,WA 98023-3456
Scheduled inspections may be failed if this card is not on-site. PO 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) .Q Ditcher(4030) 0 Slab/Concrete Floor(4255)
Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) [3 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
• Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) • 0 Ceiling Cover(4020)
Approved Approved Approved
By Date 33 -----TS S Date I 0.-S t67 By Date
® Final-Electrical(4055)
Approved
By Date
•
Rough Electrical1-1 C Final Electrical Right of Way
Approved Approved L.J Approved
By Date By Date By Date
f e �
THIS CARD IS TO REMAIN ON-SITE
curO l Wa Construction Inspection Record
Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 105813 00 Address: 1134 SW 296TH ST
Project: JIM CORNWELL FEDERAL WAY WA 98023-3456
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) ill Ditch cover(4030) ID Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
•
.. ./ .
® Pool Bonding(4195) El Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date 1 By Date By04 Date
•
El Feeders/Sub-panels(4045) ® Rough Electrical(4225) 9❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
.
El Final-Electrical(4055)
Approved
•)g Date( 6
Rough Electrical El Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF 41/11
Federal Way DEC 0 5 2017 PERMIT APPLICATION
COMMUNIIYFDEVE OPMEfYTj
PERMIT NUMBER I I 1 0
SUITE/UNIT/SPACE#
SITE ADDRESS:
//31/ S(,v / Q 1p $r
PROJECT VALUATION ASSESSOR'S T PARCEL# 0 0 n ^ CURRENT/PROPOSED USE
PROJECT NAME �� i
(Tenant or Homeowner-Last Name) ,v
CLO aur J ,m/i /6- ,oZ7/F- 00 - E '-
PROJECT DESCRIPTION '/NAL L /N gO6-L7l N WeE,1)CD
Detailed description of work to
be included on this permit only
NAME C Y,)76i/ /44 PRIMARY PHONE
PROPERTY OWNER PPA«SLCc - TAM&S" COaevo-A c (2 )y -8 '3ea
MAILING ADDRESS E-MAIL
PO 30) /2-S22-) sc/oPA/7/Si-ec. X644,1 #6C34-'
CITY STATE ZIP FAX
ck6-Er� 147,4 9&'
NAME PRIMARY PHONE
014/NO-C.--
MAILING ( ) -
ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT 074Mi✓5 eOQ,/ V\✓e�t� (Zo(n ) `/4' ' p'V3�0
MAILING ADDRESS E-MAIL
PO 8o' /282-e
CITY STATE ZIP FAX
!y/LL c2&&-e- W4 9808 z ( ) -
NAMEPRIMARY PHONE
PROJECT CONTACT 7.p ,l�S l../In 0eN w6 64 _ (z®C, )
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.
•e
SIGNATURE:/ DATE /Z -S- /2
PRINT NAME: cl ft i e---S Ce-14A11"/"--t7 L (--
Bulletin
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application