17-102520 .`
Electrical
City of Federal Way Permit #:17-102520-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: NORTHWEST FOUR SQUARE CHURCH
Project Address: 34800 21ST AVE SW Parcel Number:542350 0630
Project Description: Upgrade the existing fire alarm system.
Owner Applicant Contractor
NORTHWEST CHURCH JERAMY SHIVELT,PRESIDENTWEST WEST COAST SECURITY
34800 21ST AVE SW COAST SECURITY WESTCCS940K5(5/28/18)
FEDERAL WAY WA 98023 PO BOX I806
ORTING WA 98360 PO BOX 2304
ORTING WA 98360
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Low Voltage-Fire Alarm(Co 1
PERMIT EXPIRES Friday,25 May,2018
Permit Issued on Thursday,May 25,2017
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 .= ordance with the laws, rules and regulations of the State of
Was -'n and a- ity of Federal Way.
Owner or agent: ....0,0101111111111111rDate: 54.-41/2
3
. THIS CARD IS TO REMAIN ON-SITE r '
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 102520 00 Address: 34800 21ST AVE SW
Project: NORTHWEST CHURCH FEDERAL WAY WA 98023-3044
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.
1❑ UFER Ground(4295) ® Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date •; B• y Date By Date
•
Q Pool Bonding(4195) El 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 K. Date 111 i i 111
O Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF 411/
Federal Way MAY 2 5 2017 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOP R IT NUMBER ' _ V 2 5 2-
SUITE/UNIT/SPACE#
SITE ADDRESS: 3Z`g00 ,) /s24 A 1/€ 514/
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 50e -a0 5 `I 7 3 S- _ 0 G,
PROJECT NAME _
(Tenant or Homeowner Last Name) /✓G�/ V 1/1/co f Fou r.5& tare
PROJECT DESCRIPTION Gf" raci/ t 4e e ps 7i- 11� Eike fil6fJ-kI f- i h-7
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ,4' ytL, we;)- ClIprGb, ( )
MAILING ADDRESS E-MAIL
3'100o 2 / i"" S 14J
CITYp STATE ZIP FAX
P chrc / lit/4i(7/ ti/4 9 '7,22 (
NAME PRIMARY PHONE
()1) )255-'i(J
MAILING ADDRESS E-MAIL
ELECTRICAL PO ,6' )( 1'94,
CONTRACTOR CITY STATE ZIP FAX
?fi3‘. ( ) -
WA STATE NTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
c45-474-/'
NAME PRIMARY PHONE
APPLICANT 12,(h1/ S4"I/e /`/ (?5) )SSS- 1'I,
MAILING ADDRESS E-MAIL
Po8f /f2C
CITY STATE ZIP FAX
Orifi 9,110
NAME PRIMARY PHONE
PROJECT CONTACT L J r km)/ sh iue l/ c2)7 )ass-c1'/J k
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 t - ty as • part of this application.
SIGNATURE: ���' DATE 5;/2 7
PRINT NAM
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