15-103801 .' Electrical
44*' City of Federal Way �
Community&Econ.Dev.Services F ILE Permit #: 15-103801-00-EL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253)835-3050
Project Name: PALISOC
Project Address: 27840 25TH DR S •
Parcel Number: 757561 0650
Project Description: Install(2)new circuits
Owner Applicant Contractor
JEREMY PALISOC CHONG KIM HERTZ ELECTRIC(ELECTRICAL 01)
27840 25TH DR S HERTZ ELECTRIC HERTZE*903K1(5/22/16)
FEDERAL WAY WA 98003 757 S 116 ST 757 116TH ST S
TACOMA WA 98444-3254 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 2
PERMIT EXPIRES Wednesday, January 27, 2016
Permit Issued on Friday, July 31, 2015
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. j
Owner or agent: / ,�" Date: .7/ /I'
FF/N
41...En
- THIS CARD IS TO RE1W1 ON-SITE ,
CITY OF Construction Inspe ion-Record , -
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-103801-00-EL Address: 27840 25TH DR S
Project: JEREMY PALISOC FEDERAL WAY, WA 98003-6930
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 UFER Ground(4295) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By 1,443 Date r(24e i i S" 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) El Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Q.„10,.... Date Q`.. , ',_‘ By Date
,
El Final-Electrical(4055)
Approved
,Bj� -, Waled—\6 —tn—,
El Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
.
RECEIVED
•
JUL 31 2015 ELECTRICAL
CITY OF l'A
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER 1 S _ ) V . C5- o ' _ E (
SUITE/UNIT/SPACE#
SITE ADDRESS: 2X) s Lri,
Di S
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 6,ry �� 5 -1 5 c° / _ 065o
PROJECT NAME
(Tenant or Homeowner Last Name)
(a--) nJ C�/c,&kS
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
Sq0 )441 DIR 4°ilLkir
CITY � STATE ZIP FAX
.b LI SZ Pe-Ak.VO\r W ELj w 0\ ( )
Y PHONE
NAM
PRIMARY
r&—z . ( ) -
MAILING ADDRESSYIL /' ,1 ,� E-MAIL
ELECTRICAL 11 Oil 116 4 o L ► I
CONTRACTOR CITYSTATE ZIP FAX
l v_�°tiles W°\, st ( )
,:!)® ` /�q WA STATE CONTRACTOR'S LILICENSE'# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
O/� 1�f1 ICJ N r'1 e a- t n o K—/1 /
NAME 111 PRIMARY PHONE
VI-6
( ) -
APPLICANT
MAILING ADDRESS -'A , E-MAIL
g.' -\ ��e CITY STATE ZIP ( ) FAX
-
{\ \ 1
NAMEPRIMARY PHONE
PROJECT CONTACT CR OUC ( .-.6 ) 9_ (14'.8
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.
r
SIGNATURE: A/ L -� DATE 0 (S--
PRINT NAME: i" CAA ON) Cr) CC1 V\
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application