15-101992 .! 4 a,
II III Electrical
City of Federal Way Permit #: 15 -101992-00-EL
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609 F II LEInspection Request Line: (253)835-3050
Project Name: FREEMAN
0
Project Address: 30202 11TH PL S Parcel Number: 515390 0390
PrOject Description: New circuits for outlets,switches and lights in addition.
,
Owner Applicant Contractor
PATRICIA FREEMANC D I SYSTEMS INCORPORATED C D I SYSTEMS INCORPORATED
30202 11TH PL S PO BOX 1981 CDISYSI884NH(8/8/16)
FEDERAL WAY WA 98003 MILTON WA 98354 PO BOX 1981
MILTON WA 98354
Additional Permit Information
Is this an Online or O.T.C.application Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 4
PERMIT EXPIRES Wednesday, October 21, 2015
Permit Issued on Friday,April 24, 2015
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: V 24/-201
THIS CARD IS TO ON-SITE
CITY OF 11P11111 • Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 15-101992-00-EL Address: 30202 11TH PL S
Project: PATRICIA FREEMAN FEDERAL WAY, WA 98003-4106
Scfleduled 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.
o UFER Ground (4295) Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) ❑ Temporary Power(4275) ❑ 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 V.JI Date 5(5- ( Is— By Date
❑ Final-Electrical(4055)
Approved
By _ Date „-, ‘_vs.
❑ Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVECI
'`► AI- §, E C'TRICAL
CITY OF
' 2015
Federal Way CITY of FEDERAL WAPERMIT APPLICATION
CDS
PERMIT NUMBER / _ / 07 q
SUITE/UNIT/SPACE#
SITE ADDRESS: 362 02, u ,pc S f ctuatC i,JC �?,7Ob3
PROJECT VALUATION ASSESSOR'S TAX PARCEL3# r� CURRENT/PROPOSED USE
$ 1, 00' - 5 1 5 ? 0 - 0 .3 9 0
PROJECT NAME
(Tenant or Homeowner Last Name) gift-4-1V1414.
,.Wr/70r►o, /$4-41'°zNt Idr'-f-;vkt Ii Or 'u et-S;
PROJECT DESCRIPTION /`� G'�G/)�a' ou•1 I�13' SUS`+c�nv� / jGltar.
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 1� ; - frww►a•, ( ) -
MAILING ADDRESS E-MAIL
30202 )I+-11- /1. 51
CITY STATE ZIP G)00J? FAX
j�cr( WaY fit/Pr 33244-
O 7 ( ) -
NAME PRIMARY PHONE
D �`. Ci) sym-yvi-, irt� (3C0 ) 2 X 23 2
MAILING ADDRES% E-MAIL
ELECTRICAL Po Sox l9 S I eta ysiatirv ,' •G
CONTRACTOR CITY STATE ZIP FAX
/1/1 "ton 1AI4- 3.5Y ( ) N44--
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT /`G4/. ; ,4 /14e'21 (3(a )28b -923 2_
MAILING ADDRESS E-MAIL
Po 137;x- l 9S? cd�',ssrvl>r� /.e
Y
CITY STATE ZIP FAX
14-1) L - _ 9$'3sy ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT
KCV'ttt ii 4c M€44 (3o )20 -922 2
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 Iocal, 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.
2
SIGNATURE: ,oG DATE y"' 2 Y - 2v
//
PRINT NAME: /'S e..-V trt / � /►���►
Bulletin#160-January 1,2013 Page 1 of 2 k:\landouts\Electrical Permit Application