13-105304 •
Elkctrtai.
City ity o&Federal.Dev. y
S Permit #: 13-105304-00-EL
Community&Econ.Dev.Services
33325 8th Ave S •
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: PHANIVONG
Project Address: 30118 11TH PL S Parcel Number: 515390 0010
Project Description: Altering one circuit to replace oil furnace
Owner Applicant Contractor
SAMANTHA T PHANIVONG OLSON ENERGY SERVICE(GENERAL) OLSON ENERGY SERVICE(ELECTRICAL)
30118 11TH PLS 4415 LEARY ST NW OLSONES880MT (8/2/14)
FEDERAL WAY,WA 98003 SEATTLE WA 98107 4415 LEARY ST NW
SEATTLE WA 98107
Additional Permit Information
Is this an Online or O.T.C.application9 Yes Is Use Educational or Institutional' No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Sunday, May 25, 2014
Permit Issued on Tuesday, November 26, 2013
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy .-. . e use will be in accordance with the laws, rules and regulations of the.State of Washington
and t City of Federal Way.
i(✓ k
Owner or agen ---�'� __ -' Date: t\, L'\, k
<O
it\°.
• THIS CARD IS TO v;MAIN ON-SITE - -
CITY°F '' '" Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 13-105304-00-EL Address: 30118 11TH PL S
Project: SAMANTHA T PHANIVONG FEDERAL WAY, WA 98003-4147
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.
❑ Final-Electrical(4055)
Approved �
Byj(-, , ,
Date ' '� r/S
j,
El Rough Electrical El Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
.,
. .
A. 11110 ELtC'TRI CAL
CITY OF
Federal Way PERMIE � ICATION
I.PERMIT NUMBER 15 _ I 0 S 5 (/ -
��I ] NOV 26 2013
C �'/ CITY OF FEDERAL WAY
CDS SUITE/UNIT/SPACE#
SITE ADDRESS:
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ c.ti' t'") 4 ► V TS `i (s - O O 1 0
PROJECT NAME
(Tenant or Homeowner Last Name) r/'U.zv'tlON
P.d �� din w�cu.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
N s PRIMARY PHONE
PROPERTY OWNER nail IV Yi J1R "1 ('2c( ) SW-`&5 -
LING ADDRESS -
E-MAIL
1'2 t Ole) PL; S
CITY STATE My, FAX
Pabuti I,4/dve A' f1)'(,) ( )
NAME PRIMARY PHONE
Olin PWl Si„iI (W,, nu._ -552 t
MAILING ADDRESS E-MAIL
ELECTRICAL LI I l C Lon 441 A,- Ik � ,,�rtcc,0 c�l,y-...,�v(cc;,i..C,n
CONTRACTOR CITY / V ✓ ST TE ZIP FAX
kk 11001 c )7 ) - 1363
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CL- 0/0E-SS(r)M1 Z / Pel 70- ocl- ISH`)21- Oc aL
NAME PRIMARY PHONE
APPLICANT _ C i -1rrlcf ( ) -
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 Supp jea o ,e city as a part of this application.
/
-
SIGNATURE: f DATE /I/2 /3
3
PRINT NAME: ZG- l( •1� ik✓1!
Bulletin#160—January 1,2013 Page 1 of 2 k:AHandouts\Electrical Permit Application