15-103297 Electrical
City ty o&EFcon
alD Wv y
S Permit #: 15-103297-00-EL
Community&Econ.Dev.Services
33325 8th Ave S E
Federal Way,WA 98003 Ins ection Re Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: CLINGMAN
Project Address: 33342 12TH AVE SW Parcel Number: 926496 0640
Project Description: Alteration of(1)circuit for kichen lighting modifications.
Owner Applicant Contractor
RICHARD CLINGMAN OLD TIME ELECTRIC INC OLD TIME ELECTRIC INC
33342 12TH AVE SW PO BOX 39745 OLDTIEI021LB(6/2/16)
FEDERAL WAY WA 98023-5302 LAKEWOOD WA 98498 PO BOX 39745
LAKEWOOD WA 98498
Additional Permit Information
Is this an Online or O.T.C.application Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Monday, January 4, 2016
Permit Issued on Wednesday, July 8, 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 hof Federal Way.
Owner or agent: �r�-'max Date: .7— g
[FIN
Yu
0 THIS CARD IS TO REQ�ON-SITE -- At
CITY OF Construction Inspartion Record
Federal Way INSPECTION REQUESTS: (253)835.3050
PERMIT#: 15-103297-00-EL Address: 33342 12TH AVE SW
Project: RICHARD CLINGMAN FEDERAL WAY, WA 98023-5302
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.
O UFER Ground (4295) ❑ Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) ❑ Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
❑ Feeders/Sub-panels(4045) 'El Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
0 F. al-Electrical(4055)
Approved /
B Date e_. /i(
0 Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
• #
RECEIVED Ilk
ELECTRICAL
WY OF JUL 0 8, 2015
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER / 9 7
SITE ADDRESS: 333,a \a Pre.SO SUITE/UMT/SPACE.
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ I , 3i' ' ao 90\ 4/ 9 Co - o ( (I/ L2
PROJECT NAME
(Tenant or Homeowner Last Name) C I{eN9 r Ao."
PROJECT DESCRIPTION n5i- ��9 v
Detailed description of work to Re 11\J 3 ,ca- ESc u 6.rt\F Q(R.\ Gc S
be included on this permit only p p
NAME PRIMARY PHONE
PROPERTY OWNER ()53) 4,41- 01 (e
MAILING ADDRESS EMAIL
33 3cta ate- ,4re_ 6tA7
CITY STATE ZIP FAX
PA2,4(0AW o--
NAME PRIMARY PHONE
CkA9, S \A-c_ (aS3) 5'9g- 3‘`NS-
MAILIN DRESS E-MAIL
ELECTRICAL ly'C o..13 l y s dClbui@ ok i Vie L�ec c.
CONTRACTOR CITYSTATE ZIP FAX
�C
tom' 9Pf t (353 )< 1 - t,
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ot_C) TJ . O !L 9 tP / a //(. as-o( -moo gs'-ooQL-
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) EMAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT rY- ( 3) '6-17- 3T`6
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 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 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: \44-1C0
' DATE 7 — I5
PRINT NAME: 1010.10()\)lD"
•
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application