12-103234 w
Electrical
City of Federal Way ('
Community&Econ.Dev.Services Permit #: 12-103234-00-EL
33325 8th Ave S
Federal Way,WA 98003 t"`' t` � "
Ph (253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: BENTSON
Project Address: 33009 38TH AVE S Parcel Number: 614360 0100
Project Description: Installing up to 4 circuits
Owner Applicant Contractor
ROSS D BENTSON ALEX BURKHART EVERGREEN REFRIGERATION LLC
33009 38TH AVE S EVERGREEN REFRIGERATION (ELECTRICAL)
FEDERAL WAY WA 98001-9666 727 S KENYON ST EVERGRL882JB(4/2/14)
SEATTLE WA 98108 727 S KENYON ST
SEATTLE WA 98108
Additional Permit Information
Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 4
PERMIT EXPIRES Tuesday, January 8, 2013
Permit Issued on Thursday, July 12, 2012
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: A(29/44.-----
Date: 7/ 12-7(2—
THIS CARD IS TO MAIN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 12-103234-00-EL Address: 33009 38TH AVE S
Project: ROSS D BENTSON FEDERAL WAY, WA 98001-9666
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 Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved Approved
By Date By Date By Date /��Z--.
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
'• - i0 5
CITY OF
FedIttlypy ELECTRICAL
JUL 12 2012 PERMIT APPLICATION
F").Vol\sti electrical permits may be obtained on-line at www.cityoffederalway.com**
PROPERTY INFORMATION
SITE ADDRESS: 3.5 b ")2 -.6- S
SUITE/UNIT/SPACE# ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
!� 1 Lt la Q - 0 0 c)
PROJECT INFORMATION
PROJECT NAME
(Tenant or Homeowner Last Name) r,St;'t so r,
.1 ,4A I tAAllo► dz !'o t ) (,
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PEOPLE
NAME PRIMARY PHONE
PROPERTY OWNER �'oio I r +s , ( ; )42,7 - 0`!3c,
MAILING ADDRESS E-MAIL
,)UvAv.c. S r-6f a'►e Gori( +."cif'
CITY STATE ZIP FAX
FejtfXA ap, 1 's./A JA "1.3 cr.-). ( ) -
NAME t� p PRIMARY PHONE
[kke-/P\':•42sol ( T 1475-t P.L k1 ' ( l R)h ) 7(.3 - i 4`!'f
MAILING ADDRESS E-MAIL
ELECTRICAL .72-7 5,i-141 k�a �•
CONTRACTOR CITY STATE ZIP FAX
7 J L WPP 41S to7i : ) ,. - J-331
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PA, 26-12 8823 2- ! t4yo-t)(�- 3vC)1 i-rsv -i3t.
NAME PRIMARY PHONE
/'
APPLICANT /kW 4y i (lo 6 )14,7, - i144 401-.2.0
MAILING ADDRESS E-MAIL
72-7 kay yW, 5;• eticv6
CITY STATE ZIP FAX
°iib t C -14C Z -
NAME PRIMARY PHONE
PROJECT CONTACT 13A—
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: 014-06 pp�� -ry
DATE ! /}'I/ t�
PRINT NAME: Ale &. .
33325 8th Avenue South•Federal Way•WA•98003-6325 1 253-835-2607♦fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160-January 1,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application