17-105399 EI' frkca1
City of Federal Way Permit #:17-105399-00-EL
Community Development Dept
33325 8th AveAS
E
Federal Way,WA 98003LIM Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: NORTHWEST KIDNEY CENTER
Project Address: 33820 WEYERHAEUSER WAYS Parcel Number:215466 0040
Project Description: Low voltage cabling for DirecTV satellite system.
Owner Applicant Contractor
MJR DEVELOPMENT LORI WILSONAMERICAN TECH CORP AMERICAN TECH CORP
6725 116TH AVE NE SUITE 100 10715 PACIFIC HWY SW AMERITC951KC(5/30/19)
KIRKLAND WA 98033 LAKEWOOD WA 98499 10715 PACIFIC HWY SW
LAKEWOOD WA 98499
Additional Permit Information
Is this an Online or O.T.C.application Yes
Low Voltage-Other(Commel 1
PERMIT EXPIRES Thursday,8 November,2018
Permit Issued on Wednesday,November 8,2017
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:
ONLI Date:
N
THIS CARD IS TO REMAIN ON-SITE ,
Feclera�Way Construction Inspection Record
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 105399 00 Address: 33820 WEYERHAEUSER WAY S Unit 101
Project: HERON PARTNERS LLC 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.
. ..
l❑ UFER Ground(4295) El Ditch cover(4030) 0 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 I Approved Approved
By Date ' By Date �By Date
•t
0 Feeders/Sub-panels(4045) ' ® Rough Electrical(4225) 9❑ Ceiling Cover(4020)
Approved Approved Approved
By Date J By Date Date (,'Z Z
10 Final-Electrical(4055)
Approved
ij , Date( ( (
ID Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF ^../
Federal Way Nov 07 2017 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER ' 1 _ I 0 5 3 _ 'ea.-
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 3 o�i),..,/� �p„ter 1 awe r �� �
PROJECT VALUATION CJ ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ t ( O0C7 - ?- 1 K (' r - 0oti0
PROJECT NAME
(Tenant or Homeowner Last Name) N ( J t A•e' Gro A,-1--1/4e r
L 0 (A-) 0 o Q C_ -1 (; .. PO r
PROJECT DESCRIPTION (r e 4- v SGc- � ( ii-16 . 5)-6*/L7
Detailed description of work to
be included on this permit only
NAME W.--10(\- 1 -/ 11 PRIMARY PHONE ��/
PROPERTY OWNER N J.) C_6' d-Y r (d,O� WS- t cn 7
MAILING
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CITY /`�tJ/�� bun-- / /v FAX V
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MAILING ADDj 3 3 3L
ELECTRICAL P J6 l(�('%GC �J ct`� ih-�
CONTRACTOR CITY STAT ZI FAX �/n
WA STATE CONTRACTOR'S LICENSE# / E JRATION DATE FEDERAL WAY BUSINESS LICENSE#
(� V`I'E P TG �S t Kc_. s 21 e
NAMEl 1_ / c'-PRIMARY PHONE
APPLICANT
Lo ' w L� lk\ (dt15 &j'--1 aY'
?LING/ADDSS �q�,3 C . tor`/ � x// 'e '
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PROJECT CONTACT -1 (/te )-1
440
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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 arty 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 suppli to the city as a part of.his application. / /
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c/ - " e_."....,....4DATE /l /G 7
SIGNATURE: QJ '
PRINT NAME: O 1 ! (/—� i kJill
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application