16-1005004 0
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
FILE
Project Name: ANGELS OF AMERICA AFH
•
t Electrical
Permit #: 16 -100500 -00 -EL
Inspection Request Line: (253) 835-3050
Project Address: 4041 SW 321ST ST Parcel Number: 873190 2280
Project Description: Installation of smoke and carbon monoxide detectors.
Owner
Apolicant
Contractor
JAMES MARINO
JAMES MARINO
OWNER IS CONTRACTOR
ANGELS OF AMERICA
ANGELS OF AMERICA
1305 S 312TH ST SUITE 202
1305 S 312TH ST SUITE 202
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional Permit Information
Electrical Work Valuation?....................................487
Is Use Educational or Institutional? ....................... No
Electrical Fixtures'
Circuits - Residential ...................... 1
Is this an Online or O.T.C. application?.................Yes
PERMIT EXPIRES Friday, January 27, 2017
Permit Issued on Thursday, January 28, 2016
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 Te CeKrFederal Way. j
Owner or agent: Date: � 49/ 0/
THIS CARD IS TO MAIN ON-SITE .3
Federal Wa VA�_ -. 0THIS
In ection Record
y INSPECTION REQU TS: (253) 835-3050
PERMIT #: 16-100500-00-EL Address: 4041 SW 321 ST ST
Project: JAMES MARINO FEDERAL WAY, WA 98023-2413
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 itis 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 cover4030
❑ A roved 1:1( ) ❑ Slab/Concrete Floor (4255)
pp Approved Approved to place concrete
By Date By Date 11BY Date
❑
Pool Bonding (4195)
Approved
By
Date
0
Rough Electrical
Approved
❑
Feeders/Sub-panels (4045)
Approved
By
Date
Approved
❑
Final - Electrical (4055)
By
Approved
B
Date
❑
Temporary Power (4275)
Approved
By
Date
0
Rough Electrical
Approved
❑
Rough Electrical (4225)
Approved
By
Date
❑
Service (4235)
Approved
By
Date
0
Rough Electrical
Approved
❑
Ceiling Cover (4020)
Approved
By
Date
0
Rough Electrical
Approved
Final Electrical
Right of Way -^
Approved
Approved
By
Date
By
Date
By
Date
lk
CITY OF A
Federal Way
RECEIVED ELEC'T'RICAL
JAN 2 8 2016 PERMIT APPLICATION
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CITY OAF FEDERAL WAY
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PERMIT NUMBER (// — / / { 7 s 0
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TE/UNIT/SPACE #
PROJE DATION
ASSESSOR'S TAX/PARCEL #
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CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
ELECTRICAL
CONTRACTOR
NAME
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NAME
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PRIMARY PHONE
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CITY
STATE
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FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
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PRIMARY PRONE
(LSA ) �G 2 - j q 5
MAILMG ADDRESS
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PROJECT CONTACT
NAME
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PRIMARY PHONE
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I certgy under penalty of perjury that I am the property owner or authorised agent of the property owner. I certgy 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 authorised 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 claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be m by an erson, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of a city, incl lag its officers and employees, upon the accuracy of the
information supplied to the city as a part of this applicat n.
SIGNATURE:
PRINT
Bulletin #160 — January 1, 2013
Page 1 of 2
k:\Handouts\Electrical Permit Application
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