17-100542 a
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Electrical
City ofFederal Way Permit #:17-100542-00-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: NW WELLNESS CENTER
Project Address: 34730 PACIFIC HWY S Parcel Number:202104 9145
Project Description: Electrical wiring for monument sign install
Owner Applicant Contractor
LORRI A NICHOLS LLC QUAN'S CONSTRUCTION SRVS LLC QUAN'S CONSTRUCTION SRVS LLC
34730 PACIFIC HWY S 6520 281'H AVES QUANSCS870UD(3/4/19)
FEDERAL WAY WA 98003 SEATTLE WA 1101
6520 28TH AVE S
USA SEATTLE WA 98101
USA
Additional Permit information
Is this an Online or O.T.C.application? Yes
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Sign 1
PERMIT EXPIRES Saturday,3 February,2018
Permit Issued on Friday,February 3,2017
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
Washington and the City of Federal Way.
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Owner or a ent. � �, ate
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j THIS CARD IS TO REMAIN ON-SITE
��' Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 100542 00 Address: 34730 PACIFIC HWY S
Project: LORRI A NICHOLS LLC FEDERAL WAY WA 98003-6821
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 lel 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) ••Q Ditch cover(4030) „0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
.By Date By Date By Date
® Pool Bonding(4195) S❑ Temporary Power(4275) ® Service(4235)
Approved Approved Approved
.By Date '6:By Date : By Date
® Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
10 Final-Electrical(4055)
Approved
By 0_41.1/410 Date a ,s s,...1 Si ,
El Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
.By Date By Date By Date
`
CITY OF
ELECTRICAL
Federal Way j PERMIT APPLICATION
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CrPr 51 A PERMIT NUMBER 7- r 0 0 5 a 00
SUITE/UNIT/SPACE#
SITE ADDRESS: tel 0 Dp Qa. ��, ,�,,/ S .
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# � � _ ;171--S CURRENT/PROPOSED USE
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PROJECT NAME {.e__ l.c -- N W YV E/(I)e g
Tenant or Homeowner Last Name
PROJECT DESCRIPTION r ,� �.�
Detailed description of work to
be included on this permit only
3 S'— -- -2-c) r
NAME PRIMARY PHONE
PROPERTY OWNER -�K� (Z_S ) 2-C1
MAILING ADDRESS E-MAIL
3c.E? 3 0S .
TY TATE ZIP FAX
I,VA�
9e001 ( ) -
NAME PRIMARY PHONE
6sZo 2.A: , (2-06) 11S: 2_6S-1
MAILING ADDRESS C E-MAIL
ELECTRICAL �- � - .c a't,� 3e�
CONTRACTOR CIT7G STATE ZIP `l
`/'7t FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT MAILING "-^`- � ( )33S 2G S3
ADDRESS E-MAIL
Cc.52.o 2--g+& bocts,C . .
CITY .G- STATEZIP ( ) FAX
NAME e . we (-�`E 1 O U
PRIMARY PHONE
PROJECT CONTACT -) J 2p (
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 the city as a part of this application.
SIGNATURE: fel I. DATE ^ '3 '�'
IIP
PRINT NAME: a r ( 621.„L„ a' !
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application