17-104939 .
Electrical
City of Federal Way Permit #:17-104939-00-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: COSTCO GAS STATION
Project Address: 35100 ENCHANTED PKWY S Parcel Number:219260 0290
Project Description: Remove and replace the existing Gilbarco two-product dispensers.Install new hoses,nozzles,
and breakaway valves.Extend the existing dedicated power for the Ethernet disconnect.
Disconnect& reconnect the power,data CRIND and controls.
Owner Applicant Contractor
COSTCO WHOLESALE CORP PACIFIC NORTHERN ENVIRONMENTAL PACIFIC NORTHERN ENVIRONMENTAL
999 LAKE AVE DR SUITE 201 CORP CORP
ISSAQUAH WA 98027 1121 COLUMBIA BLVD PACIFNE022MH(7/1/18)
LONGVIEW WA 98632 1121 COLUMBIA BLVD
LONGVIEW WA 98632
Additional Permit Information
Is this an Online or O.T.C.application? Yes
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PERMIT EXPIRES Friday, 12 October,2018
Permit Issued on Thursday,October 12,2017
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 accordance with the laws, rules and regulations of the State of
Wasrand e City of Federal Way.
Owner or agent:411f ��� _ Date: 1'0/17,--(7.0/'7
c*----\ 8..i"-\._gSfi)'-'
1
14044 THIS CARD IS TO REMAIN ON-SITE
Federal Way Construction Inspection Record
INSPECTION REQUESTS :(253)835-3050
PERMIT#: 17 104939 00 Address: 35100 ENCHANTED PKWY S
Project: COSTCO WHOLESALE CORP FEDERAL WAY WA 98003
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.
0 UFER Ground(4295) El Ditch cover(4030) 9 1:1 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date J.By Date ABy Date
® Pool Bonding(4195) ' 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date i By Date ; By Date
,0 Feeders/Sub-panels(4045) • $ RoughElectrical(4225) •,ElCeilingCover 4020 *
p ❑ ( )
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055)
Approved
By C\4v.7 Date fa _ 1 _ l it. .
0 Rough Electrical
0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By 'Date - By Date
CITY OF
DECEIVED Costco Loc. No.061 /BCE#6076.19
ELECTRICAL
OCT 1 2 2017
Federal Way PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT 1 Q Z G _
PERMIT NUMBER I / a 10 27 I J l
.___ SUITE/UNIT/SPACE ii
SITE ADDRESS: 35100 Enchanted Parkway South, Federal Way, WA 98003-8314
PROJECT VALUATION ASSESSOR'S TAX/PARCEL It CURRENT/PROPOSED USE
S 19,000.00 219 260 01 80 - Gasoline Dispensing
Facility
PROJECT NAME
(Tenant or Homeowner Last Name) Costco Gasoline(Loc. No. 61)
Remove the existing Gilbarco two-product dispensers I Install new Gilbarco Encore 700S Series Model NG4
two-product dispensers on the existing islands. I Install new(like for like)hoses,nozzles,and breakaway
PROJECT DESCRIPTION valves(or reuse existing). J Perform any and all purging.regulatory testing.and calibration on the
Detailed descriptionof work to newly-installed dispensers. I Extend the existing dedicated power for the Ethernet disconnect(The Ethernet
he included on this permit only disconnect is to be completed under a separate permit).I Disconnect&reconnect the power,data,GRIND and
controls
NAME PRIMARY PHONE
PROPERTY OWNER Costco Wholesale (Loc. No. 61) ( 425 ) 313 -8100
MAILING ADDRESS E-MAIL
P.O. Box 35005 Dlarson@costco.com
CITY STATE ZIP FAX
Seattle / /7�,��q�. _/WA 988124--3405 ( ) -
-- ...el..,__ .. .......emu Ivy II ektipl 1 , , 07 IT` ,i# PRIMARY PHONE. _..._..
�0 �I Cat-f, ( 360 ) 423 - 2245
MAILING ADDRESS E-MAIL
ELECTRICAL 1121 Columbia Blvd
CONTRACTOR CITY STATE ZIP FAX
Longview WA 98632-1002 ( )
WA STATECONTRACTOR'S LICENSE S EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE it
aov A N Frgg1 R�' 12/31 /2017 20-14-100913-00-BL
NAME j PRIMARY PHONE
APPLICANT 110.4-/4/ �/e Ow ) (a3(,-ZSc4
MAILING ADDRESS EMAIL
//Z/ COLI �,6,9- .3e do, n)4O 'r-PiQ Cort
CITY/ STATE ZIP FAX
G.6r4t/6-1/1 4(4- 9� k3i�0)`-a3 - Z- Z7Z
NAME PRIMARY PHONE
PROJECT CONTACT D ii N ('�, .0)c --10e1)57
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 • ss t•= City a ederal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and de -nse of. h clod hich may be made by any person, including the undersigned,and filed against the city,
but only where such • aim • s out o, e reliance of the city, including its officers and employees, upon the accuracy of the
information supplied o the /as a par -f this application.
SIGNATURE: / "0 DATE /0 2-0/7
PRINT NAME: /AM/L1//AMii,it ,��
PERMIT CENTER+33325 80'Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 + percnitcentertu:cityofrederalway.coln
Bulletin 4160--April 14,2016 Page 1 of 1 k:11landoutsAElectrical Permit Application