16-101127City of Federal Way
Applican
Community & Econ. Dev. Services
CITY OF FEDERAL WAY - PARKS
33325 8th Ave S
OWNER IS CONTRACTOR
Federal Way, WA 98003
F11
Ph: (253) 835-2607 Fax: (253) 835-2609
FEDERAL WAY WA 98063
Project Name: TOWN SQUARE PARK
.
Project Address: 31600 PETE VON REICHBAUER WAY S
Electrical
Permit #: 16 -101127 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 092104 9021
Project Description: Install 2- 2 1/2 conduits for secondary power supply to the park and for IT communications
Owner
Applican
Contractor
CITY OF FEDERAL WAY - PARKS
STEVE IKERD
OWNER IS CONTRACTOR
PO BOX 9718
CITY OF FEDERAL WAY - PARKS
FEDERAL WAY WA 98063
33530 1ST AVE S
FEDERAL WAY WA 98003
Additional Permit Information
Electrical Work Valuation?....................................3000.00 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No Service greater than 999 Amps? ............................. No
Electrical Fixtures
New Service: 0 - 100 amus (Comm 1
PERMIT EXPIRES Saturday, March 4, 2017
Permit Issued on Friday, March 4, 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 the City of Federal Way.
Owner or agent: � ' Date: ?J' � • � b
CITY of
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
16 -101127 -00 -EL Address: 31600 PETE VON REICHBAUER WA`
Project: 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
El
LIFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
13
Approved
By
Approved
Approved to place concrete
By
Date
By
L�Y Date 3 , , S7b
By
Date
Final - Electrical (4055)
Approved
By Date
El
Pool Bonding (4195)
E]
Temporary Power (4275)
13
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Ceiling Cover (4020)
■
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
PERMIT NUMBER
ELECTRICAL
10 1 � 77- 00 MAR 042016
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SITE ADDRESS' 31600 V CDS
SUITE/UNIT/SPACE #
PROJECT VALUATION
$366VRaw
ASSESSOR'S TAX/PARCEL #
CURRENT/PROPOSED USE
PROJECT PROJECT NAME
(Tenant or Homeowner Last Name)
1' 11M Y6,Jf�j or�r
(�U13 "n IA�X� P'�lii�
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
/Z COYNAU-A-5, -aw 5t�um�a�r
CeY Su l + � ay�- • AX so +v\.5k-pM a
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDOESS
E-MAIL
CITY
4AV"O i
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME o\
VV
PRIMARY PHONE
( )
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
MAILING ADDRESS
Sam as -.;Apo Jam•
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
� � ` � >
PRIMARY PHONE
( )
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 part of th' lication.
SIGNATURE: p DATE �� L
PRINT NAME: S
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application