13-100447 Electrical
City of Federal Way "� -' Permit #. 13-100447-60a-EL
Community Econ. Jev.Services •
33325 8th Ave S r ;
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 _ Inspection Request Line. (253) 835-3050
Project Name: PEDERSON
Project Address: 28124 23RD AVE S Parcel Number: 326081 0330
Project Description: Electrical work for living room/den remodel w/bathroom addition.
Owner Applicant Contractor
JAMES PEDERSON JAMES PEDERSON OWNER IS CONTRACTOR
28124 23RD AVE S 28124 23RD AVE
FEDERAL WAY WA 98003-2962 FEDERAL WAY WA 98003-2962
Additional Permit Information
Is this an Online or O.T.C.applications Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 4
PERMIT EXPIRES Sunday, July 28, 2013
Permit Issued on Tuesday, January 29, 2013
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the se will be in accordance with the laws, rules and regulations of the State of Washington
a d_91--- City f Federal Way. r?
Owner or agent: ( Date: 1
e Alp / 130
THIS CARD IS TO MAIN ON-SITE
CITY OF - Construction In ection Record •
Federal Way INSPECTION REQUE TS: (253)835-3050 '
PERMIT#: 13-100447-00-EL Address: 28124 23RD AVE S
Project: JAMES PEDERSON FEDERAL WAY, WA 98003-2962
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) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
•
❑ Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
o Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date ByO.--: Date By Date
0 Final-Electrical(4055)
Approved
By fl, . Date _6 _ --
❑ Rough Electrical Final Electrical111 Right of Way
Approved Approved Approved
By Date By Date By Date
•RECEIVED
N 2 9 2013 EL CTRICAL
CITY OF
Federal Way CITY OF FEDERAL WAX PERMIT APPLICATION
CDS
PERMIT NUMBER / _ I Q L (( 7 -
SITE ADDRESS: �� SUITE/UNIT/SPACE#
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PROJECT VALUATION ASSESSOR'S TAX/PARCEL i CURRENT/PROPOSED USE
�7 c 620 ( _ 03 3v
PROJECT NAME
e(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION ( e d /c
Detailed description of work to U`i Ul /1, — y o C `7." Lj`(f�Z -
be included on this permit only /
NAME ,,.�.� I PRIMARY PHONE
PROPERTY OWNER J 1-cy' � Q7�jt.Sam' (2C( ) c fit - ( Co 7 (
MAILING ADDRESS E-MAIL
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CITY Y---� STATE ZIP FAX
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) , �/ ) -
NAME V PRIMARY PHONE
/V1AJ
( )
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 D ( )
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 o the city, including its officers and employees, upon the accuracy of the
information supplied e 'ty as a part of this applicgtio
SIGNATURE: DATE 2-47 / 3
PRINT NAME: : A v A V E5 ( • ���'�1 �- id—'
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application