14-101896Electrical
City of Federal Way Permit #: 14 -101896 -00 -EL
Commurnty &Econ. Dev. Services
33325 8th Ave S
Federal way, WA 98003
FILE
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection Request Line: (2
53) 835-3050
Project Name: TOWN SQUARE PARK
Project Address: 31600 20TH AVE S Parcel Number: 092104 9021
Project Description: Install 600 lineal feet 2" sch 40 pvc pipe, 24" deep for 2" conduit for future lighting and
outlets
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Service greater than 999 Amps? .............................No
Electrical Fixtures
New Service: 10 1 - 200 amps (Corr 1
Is Use Educational or Institutional? ....................... No
PERMIT EXPIRES Wednesday, October 22, 2014
Permit Issued on Friday, April 25, 2014
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
V=
th City of Federal Way.
Owner or agent: Date: C `d 1C�—
Owner
Anulicant
Contractor
CITY OF FEDERAL WAY - PARKS
CITY OF FEDERAL WAY - PARKS
CITY OF FEDERAL WAY - PARKS
33325 8TH AVE S
33325 8TH AVE S
33325 8TH AVE S
FEDERAL WAY WA 98003-6325
FEDERAL WAY WA 98003-6325
FEDERAL WAY WA 98003-6325
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Service greater than 999 Amps? .............................No
Electrical Fixtures
New Service: 10 1 - 200 amps (Corr 1
Is Use Educational or Institutional? ....................... No
PERMIT EXPIRES Wednesday, October 22, 2014
Permit Issued on Friday, April 25, 2014
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
V=
th City of Federal Way.
Owner or agent: Date: C `d 1C�—
INSPECTOR
AREA ANDTYPE
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CITY OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
14 -101896 -00 -EL Address: 31600 20TH AVE S
CITY OF FEDERAL WAY - PARKS FEDERAL WAY, WA 98003-5426
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
By Date
® Rough Electrical Final Electrical ❑Right of Way
Approved Approved Approved
By Date By Date By Date
UFER Ground (4295)
Ditch cover (4030)
El
Slab/Concrete Floor (4255)
Approved
Approved _
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
® Rough Electrical Final Electrical ❑Right of Way
Approved Approved Approved
By Date By Date By Date
Pool Bonding (4195)
0
Temporary Power (4275)Service
(4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
❑
■
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
® Rough Electrical Final Electrical ❑Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF V&
Federal Way
PERMIT NUMBER _
ELECTRICAL
PERMIT APPLoTION
APR 252014
CITY OF FEDERAL WAY
SITE ADDRESS: O �� 1/�" ,
SUITE/ ACE t
PROJECT VALUATIpO-N��
ASSESS((��$$��,::1S TAB/PARCEL i C(
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
TCS P IN�kc—
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only.
1
V�
PROPERTY OWNER
NAME
PRIMARY PHONE
-
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
(
ELECTRICAL
CONTRACTOR
NAME ` n
PRIMARY PHONE
MAILING ADDRESS
E-MAII.
CITY
STATE
ZIP
FAX
( 1 -
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
APPLICANT
NAME a
L/l
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME ` % ! `
c-- z,^ \ `
PRIMARY PHONE `
( ��S 7� \
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 Iaws.
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 of this application 7
SIGNATURE: DATE
DATE ,
PRINT NAME:
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application