13-102268 OECEIVED
‘16' MAY 23EL CTRI CAL
CITY OF 2013
Federal Way Cm OF FEDERAL WAY PERMIT APPLICATION
CDS/�
PERMIT NUMBER I _ ) (/J
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SUITE/UNIT/SPACE a
SITE ADDRESS: 00 �a N S7
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 3S0 _°° - - - - - - - -
PROJECT NAME 4- (�i��A I 0,
(Tenant or Homeowner Last Name) E Vl� r'� �E't� � cri
1
PROJECT DESCRIPTION hPF(a�'•P SSS�� F �5 pa P ` w t t� cr IntPc(Z o ,ne
Detailed description of work to 1
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNERk �Q
l
MAILING I����� �us` J
AA() ( )57� - 1233
1200 tc ov �- Po k w, LE MALL
CITY STATE ZIP
// FAX
NAME PRIMARY PHONE
AF
MAILING ADDRESS E-MAIL,
ELECTRICAL
CONTRACTOR CITY STATE MLP FAX
( )
WA STATE CONTRACTOR'S LICENSE a EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PRIMARY PHONE
APPLICANT NAME
Ati
(10 � 4 (X6)P71 -' 7 3
MAILING ADDRESS ,{Q A//A, E-MAIL
CITY J t/ 1 u STATE ZIP FAX
( )
PROJECT CONTACT PRIMARY PHONE
NAME
ate, k�1 �,-�- ci)g.?1 - H67•
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: DATE ....51/43/PRINT NAME: Act re) \1\y\-4--
v�
Bulletin#160—January 1,2013 Page 1 of 2 k:11-Iandouts\Electrical Permit Application
4110 •
• 'Electrical
City of Federal Way Permit #: 13-102268-00-E L
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003 Line:Request
Ph:(253)835-2607 Fax (253)835-2609Inspection (253)835-3050
Project Name: EVERGREEN COURT APARTMENTS BLDG I UNIT 27 27o/tQ�
Project Address: 33004 19TH LN S I-27 Parcel Number: 797880 0460
Project Description: Replace 0-20,0 amp panel
Owner Applicant Contractor
KING COUNTY HOUSING AUTHORITY KING COUNTY HOUSING AUTHORITY OWNER IS CONTRACTOR
600 ANDOVER PARK W 600 ANDOVER PARK W
TUKWILA,WA 98188-3326 TUKWILA,WA 98188-3326
Additional Permit Information
Is this an Online or O.T.C.application Yes Is Use Educational or Institutional? No
Service greater than 999 Amps? No
Electrical Fixtures
Alt.Serv./Feeder:0 to 200 amps(Is 1
PERMIT EXPIRES Tuesday, November 19, 2013
Permit Issued on Thursday, May 23, 2013
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: —' Date:
THIS CsA.%
• ARD IS TO MAIN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQ TS: (253)835-3050
PERMIT#: 13-102268-00-EL Address: 33004 19TH LN S 1-27
Project: KING COUNTY HOUSING AUTHOR FEDERAL WAY, WA
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.
El LIFER Ground (4295) ❑ Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
. . . .
El Pool Bonding(4195) 0 Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
• . ,
El Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
` '
final-Electrical(4055) /
')A.7
Approved f/J
By 7Date
0 Rough ElectricalEl Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date