15-102242 E)ectriCa1 '
City of Feder
Community&Econ F ILE Permit #: 15-102242-00-EL
.Dev.Services
S
33325 8th Ave S
Federal way,wA 98003
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253)835-3050,
:
Project Name: MONSEN •
Project 28247 TH S Parcel Number: 231240 0170
Project Description:Address: Installati27on of smokeAVE &CO2 detectors.
Owner Applicant Contractor
PAMELA MONSEN HERTZ ELECTRIC HERTZ ELECTRIC
5024 S TRAFTON ST 757 116TH ST S HERTZE*903K1(5/22/16)
TACOMA WA 98409-7144 TACOMA WA 98444 757 116TH ST S
TACOMA WA 98444
•
Additional Permit Information
Is this an Online or O.T.C.application Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Saturday, November 7, 2015
Permit Issued on Monday, May 11, 2015
I hereby certify that the above inform *on is correct a d tha a construction on the above described property and
the occupancy and the use will be in c• •:nce the ws, rules and regulations of the State of Washington
n City o ederal Way.
Owner or agent „fir _.. Date:
�1
•
s " * THIS CARD IS TO ovIAIN ON-SITE f .
CITY OF400411& Construction Inspection Record
Federal vvay INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-102242-00-EL Address: 28247 27TH AVE S
Project: PAMELA MONSEN FEDERAL WAY, WA 98003-3306
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.
O LIFER Ground(4295) ❑ 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) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
O Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
❑ Final-Electrical(4055)
Approved
By r� ,4 Date n.r„-,S .
❑ Rough Electrical Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED • ••
�► n 0 ELECTRICAL
CITY OF
Federal W 112015 PERMIT APPLICATIQN
CITY OF FEDERAL WAY
PERMIT NUMBER / 0
SUITE/UNIT/SPACE#
SITE ADDRESS:9 �2 �)
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# � � - Q � � O CURRENT/PROPOSED USE
$ S
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION �� �'b's�"K'C �° ( ,47L) D/o,k?4
Detailed description of work to -Dn-
be included on this permit only �'(
N PRIMARY PHONE
PROPERTY OWNER � 0 < ) ( ) -
MAILING ADD S E-MAIL
CITY S ATE IP FAX
7 A 10A 98 9 ( ) -
NAME PRIMARY PHONE
bLQ- )
MAILING ADDRESS E-MAIL
ELECTRICAL `7 S 7 j/ 5/'
CONTRACTOR CITY STATE ZIP FAX
)
WA ACONTRACTOR'S ICENSE# a EXPIRAnos DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT , L�ss ��CJ� ( ) E-MAIL
CITY STATE ZIP FAX
( )
N PRIMARY PHONE
PROJECT CONTACT
Pr -)C3r14
�< ( )
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 tihe'City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of sucitt claim), which may be made by -ny person,including the undersigned,and filed against the city,
but only where such claim arises citft of the reliance of the city including its officers and employees, upon the accuracy of the
information supplied to the city as.a art o 60 is application
SIGNATURE: / r < s DATE5:// )S
PRINT NAME:
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application