13-104970 •
•
LE
_ Electrical
City ofFederal way F
Community&Econ.Dev.Services Permit #: 13-104970-00-EL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609Inspection Request Line: (253)8355-30550
Project Name: AESTHETIC DENTAL
Project Address: 34704 11TH PL S Parcel Number: 215470 0030
Project Description: Adding/altering(30)circuits for associated tenant improvement
•
Owner Applicant Contractor
VC INVESTMENT LLC FULFORD ELECTRIC FULFORD ELECTRIC
14349 SE 92ND ST 11172 SABER LN SE FULFOE*881DE(3/8/14)
NEWCASTLE,WA 98059 PORT ORCHARD WA 98367 11172 SABER LN SE
PORT ORCHARD WA 98367
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
Circuits-Commercial 30
PERMIT EXPIRES Monday, May 5, 2014
Permit Issued on Wednesday, November 6, 2013
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 �f ,_. ._ /,i_ s. Date: / —/7- / 3
S�,fv�
. — THIS CARD IS TO MAIN ON-SITE , ,
CITY OF , Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 13-104970-00-EL Address: 34704 11TH PL S
Project: VC INVESTMENT LLC FEDERAL WAY, WA 98003-6715
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.
0 UFER Ground (4295) El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
o Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By c..., J Date `Q.„‘01_-3 , By 0rN Date ......,-&o..._\
O Final-Electrical(4055)
Approved
By u&j Date If-
El Rough Electrical El Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
IIIELECTRICAL
� Y
CITY OF _
Federal Way PERMIT APPLICATION
RECEIVED
PERMIT NUMBER l / - I b 4 `� f i - N O V G 6 2013 O13
CauteaRlifeF*Re rWAY
SITE ADDRESS: �Q�_ ' 1. s6�� �l �I r�Y ' fa 9803'/ CDS
PROJECT VALUATION '7�' ASSESSOR'S TAX/PARCELP I /'�Ue7► K/�W� �7 CURRENT/PROPOSED USE
$ 07st�o Z ( 5- del- 7Q -
PROJECT NAME A CCW-k-77( V.E- r TA r
(Tenant or Homeowner Last Name) Voc)n ✓ J� V
� -� di-e — - - -n•Qcar.crrtet`t—
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PRIMARY PHONE
PROPERTY OWNERNAIL-. Vim) Vo)N ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
NAME PRIMARY PHONE
MAILING ADDRESS t E-MAIL /
ELECTRICAL /i(7 . �4)21cf - L.&) S& hrvack. v�gde , •�
CONTRACTOR C o STATE ZIP FAX
i6r -----C--c kce( k1A 9,069 ( ) _
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
,4-6- Fut CEA 90 ISE 3 'Jy ao-/3-/0416(0-00-8/
NAME PRIMARY PHONE .w. .
APPLICANT ADDRESS
gr1fA-) ( ) -
MAILING/// (2 ..SE-- 0 1 -; i
COn
STATE ZIP
ITY
- c
,�. k citge36.- ( ) FAX
NAME PRIMARY PHONE
PROJECT CONTACT I ..)3Q - 6 423� /
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 supplied to the city as a part of this application.
SIGNATURE:. #E_ DATE 1/—6— ' ./3PRINT NAME: 'rl An)
i' /
Bulletin#160—January 1,2013 Page 1 of 2 kaHandouts\Eiectrical Permit Application