18-100724 Electrical
City of Federal Way Permit #:18-100724-00-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: THE CHOPPED LEAF
Project Address: 35002 PACIFIC HWY S Parcel Number: 185295 0050
Project Description: Electrical connection for illuminated channel letter signage.
Owner Applicant Contractor
FEDERAL WAY CROSSINGS FEDERAL WAY SIGN LLC(GENERAL 01) POITRAS SIGN&LIGHTING
10655 NE 4TH ST SUITE 700 34205 18TH PLS (ELECTRICAL 04)
BELLEVUE WA 98004 FEDERAL WAY WA 98003 POITRSL881LG(6/7/18)
8515 189TH AVE SE
SNOHOMISH WA 98290
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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PERMIT EXPIRES Thursday,14 February,2019
Permit Issued on Wednesday,February 14,2018
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
Was ' on and the City of Federal Way.
Owner or agent: Date: -
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41k RECEIVE ELECTRICAL
CITY OF
Federal Way FEB 14 2018 PERMIT APPLICATION
CITY OF FEDERAL;... (')
COMPAUNITY DEVE'' PERMIT NUMBER I & - / 0 V 2- Cf -
( SUITE/UNIT/SPACE#
SITE ADDRESS: - c202 c,,,,
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PROJECT VALUATION ASSESSOR'S TAX/PARCEL , CURRENT/PROPOSED USE
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PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION L �' " e " �-_ - ct.,)___
Detailed description of work to
be included on this permit only
NAMEPRIMARY PHONE
PROPERTY OWNER ' 11'" - ( )
MAILING ADDRESS r E-MAIL
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CITY STATE ZIP FAX
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NAME PRIMARY PHONE
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MAILING ADDRESS E-MAIL
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CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME "` � PRIMARY PHONE
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APPLICANT MAILING ADDRESS V E-MAIL
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CITY STATE ZIP FAX
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NAME PRIMARY PHONE
PROJECT CONTACT -OLA ••-- ( )
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 f the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a p of this application.
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SIGNATURE: DATE 2 - 'Lt - ��18
PRINT NAME: U /U- cG) L&(--
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application