14-105768 •
' ectrcal
City of Federal D Way Permit #: 14-105768-00-E L
Community&Econ. ev.Services
33325 8th Ave S
Federal Way,ac 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: FEDERAL WAY HIGH SCHOOL-TEMPORARY PORTABLE P-24
Project Address: 30611 16TH AVE S Parcel Number: 082104 9001
Project Description: Installation of intercom and wireless clock system.
Owner Applicant Contractor
FEDERAL WAY PUBLIC SCHOOLS ELECTROCOM ELECTROCOM
33330 8TH AVE S 6815 216TH ST SW ELECT**137DP(3/17/15)
FEDERAL WAY WA 98003 LYNNWOOD WA 98036 6815 216TH ST SW
LYNNWOOD WA 98036
•
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
PERMIT EXPIRES Monday, May 4, 2015
Permit Issued on Wednesday, November 5, 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
e ' Federal Way.
Owner or agent: Date:
• THIS CARD IS TO MAIN ON-SITE
CITY CIFConstruction In ection Record '
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 14-105768-00-EL Address: 30611 16TH AVE S
Project: FEDERAL WAY PUBLIC SCHOOLS FEDERAL WAY, WA 98003-4903
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) El Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) ❑ Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date •
O Feeders/Sub-panels(4045) El Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
O Final-Electrical(4055)
Approved
By j\14-N Date Z.—\-1.-1 L
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
•
RECEIVED • ' z
NOV 0 3 2014 ELECTRICAL
CITY OF
Federal Way CITY OF FEDERAPV `MIT APPLICATION
CDS
PERMIT NUMBER / q — ( 0 S 7 6 7 _ ,L(
III
44.1
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 D6(/ /C - A $, rI--t- a 4
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ as , 17.6 O 1 o_ l' Q O /
PROJECT NAME I /' l // [�
(Tenant or Homeowner Last Name) Fed F'�"? way /'t r(�' t Jr L'� 1 t `
11,75.4-4 11 g4-lo-. ems? /✓1Trvcos.-� c it Lsi( 1,..fc C�Ioc4
PROJECT DESCRIPTION _Cy Sf-e'r i e^ in e p(s,,4-.761.05
Detailed description of work to
be included on this permit only
NAME I I PRIMARY PHONE
PROPERTY OWNER real ei•-v (,ti.ry# 5c l'►0'01 0/f Lric-f' G25:3)7ei ac ,o
MAILING ADDRESS 33331 ) gI CVe $0 `—L E-MAIL
CITY f&J4y9I (t, r. STATE ZIP FAX
12147- C71c73 ( ) -
NAME t PRIMARY PHONE
e- vCC,eon
MAILING ADDRESS E-MAIL
ELECTRICAL 6 8/5' 2l.6 -51- 5 w
CONTRACTORCITY STATE ZIP FAX
L-1 htrJr,o d 4 Z.. 9P 0346 ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
'�LT EC1.37.DP 3 I7 15 a6'-dq-/0327e-O'-61-
AME PRIMARY
APPLICANT NCI C 4-✓'[7Ca`on (LOST ST PHS
o '
MAILING ADDRESS ft. EMAIL
6'8/..r aI* 5`F- Sw
CITY STATE ZIP FAX
L.yh v»oa.d Lae( ggo36 ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT (/.51:2., FP J i ffs.. ,/1.255'os- C7755-
I certify under penalty of perjury that I am the property owner or authorised 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 authorised 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.
4...oz.__ /
SIGNATURE: 'C/F. DATE /' /I 3///y
PRINT NAME: CC5(I✓1 6 red Lcie',.-,
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application