14-102416 {
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._, • • Eectricai
City of FeWay Permit #: 14-102416-00-EL
Community&Econ.on.Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: SHIELDS `5 ')-
Project Address: 28538 20TH AVE S Parcel Number: 422200 0210
Project Description: Replace fire-damaged meter base.
Owner Applicant Contractor
BARBARA E SHIELDS D&A ELECTRIC LLC D&A ELECTRIC LLC
28538 20TH AVE S 33410 30TH AVE SW DELEC*E897D5(4/5/15)
FEDERAL WAY WA 98003 FEDERAL WAY WA 98023 33410 30TH AVE SW
FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Electrical Fixtures
Mast or Meter Repair(Residential/ 1
PERMIT EXPIRES Wednesday, November 19, 2014
Permit Issued on Friday, May 23, 2014
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: e, -/4'
FINALED
THIS CARD IS TO MAIN ON-SITE
circ ot• �.,:� �
Construction In ection Record -
-
Federal Way INSPECTION REQU TS: (253)835-3050
PERMIT#: 14-102416-00-EL Address: 28538 20TH AVE S
Project: BARBARA E SHIELDS FEDERAL WAY, WA 98003-3233
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) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) 0 Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) .0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
I .
❑ ..,)( Final-Electrical(4055)
Approved
By r - Date 1 1 ($"I (
4 Pcv .Pse tut4-cv clop rova 1
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
•
►. ecENED
ELCTR,ICAL
CITY OF
Federal Way MAY 2 3 2014 PERMIT APPLICATION
CITY OF FEDERAL WAY
PERMIT NUMBER /r i( _ / 0
' SUITE/UNIT/SPACE#
SITE ADDRESS_ 1
PROD T"0"..VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION tirV±P - 1(a2-4C
Detailed description of work to fl
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER AJ, (a3 ) S 1
MAILING ADDRESS E-MAIL
CITY STATE ZIP
FAX
teCIC-()LAI
NAME} _ PRIMARY PHONE
4 7 !'/C- ( i)b1'74-/-
MAILING ADDRESS E-MAIL
ELECTRICAL '-2,36-//(
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S/LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
OEL E C✓ 7 S
NAME
PRIMARY PHONE
APPLICANT O ( -�,' (25J )(��� g 7/C.'
MAILING
E-MAIL
CITY STATE ZIP FAX
_( )
NAME PRIMARY PHONE
PROJECT CONTACT
al v') C,.��;n (2'53 )
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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.
SIGNATUREg - DATE 5- -7. �e
i
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Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application