14-101574f s
'Electrical
Commune & Ecom. Dev.ay
Services Permit #: 14 -101574 -00 -EL
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line:
Ph: (253) 835-2607 Fax: (253) 835-2609 Yi p eq (253) 835-3050
Project Name: FRANCISCAN MEDICAL CLINIC
Project Address: 30809 1ST AVE S Parcel Number: 072104 9244
Project Description: Installation (3)120-v receptacles.
Owner
ARplicant
Contractor
FRANCISCAN MEDICAL CLINIC -
SEA -TAC ELECTRIC INC
SEA -TAC ELECTRIC INC
FEDERAL WAY
7056 S 220TH ST
SEATAEI077RW (12/17/15)
1313 BROADWAY PLAZA SUITE 200
KENT WA 98032
7056 S 220TH ST
TACOMA WA 98402
KENT WA 98032
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
Circuits - Commercial. ................... 3
PERMIT EXPIRES Saturday, October 4, 2014
Permit Issued on Monday, April 7, 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 Jhe laws, rules and regulations of the State of Washington
and of Federal Way. �/ j
Owner or agent: Date: / — /
THIS CARD IS TO REMAIN ON-SITE
Federal Way 41A Construction Inspection Record
y INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 14 -101574 -00 -EL Address: 30809 1 ST AVE S
Project: FRANCISCAN MEDICAL CLINIC - F FEDERAL WAY, WA 980034090
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.
Approved
By Date
0 Pool Bonding (4195)
Approved
By Date
Feeders/Sub-panels (4045)
Approved
By Date
Final - Electrical (4055)
Approved
By O J$ Date +11,114
0
Ditch cover (4030)
Slab/Concrete Floor
By
Approved
1:1Approved
Approved to place concrete
By
Date
By
Date
0
Temporary Power (4275)
Approved
By
Date
1:1Approved
Right of Way --�
Rough Electrical (4225)
Date
Approved
By
Date
Service (4235)
Approved
By
Date
1:1Approved
Right of Way --�
Ceiling Cover (4020)
Date
Approved
By
Date
Rough Electrical
Approved
1:1Approved
Final Electrical
1:1Approved
Right of Way --�
By
Date
By
Date
By
Date
CITY OF 1A
Federal Way
i
"'R 0 7 2014
EiECTRICAL
CITY OF FEDERAL vPERMIT APPLICATION
CDS
PERMIT NUMBER / �— _ 1 / � 5 / —Y_
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 rift part of this application.
SIGNATURE: DAT)6
PRINT NAME __ yes. �.✓--._ d i._._ _.._ _ �7���
Bulletin #100 January 1, 2013 Page I of 2 kAHandouls0coricai Permit Application
SUITE/UNIT/SPACE N
SITE ADDRESS:
PROJECT VALUATION
$ 5-000c)
ASSESSOR'S TAX/PARCEL N
-0 -7 -A----1 0 S ?-,A -��-
, CURRENT/ PROPOSED USE
PROJECT NAME'J
('tenant or Homeoli ner Last Name)
iz ro E ec.0-t 4-/' /%%6/0 / GAG-
�-
O A t_ ,f c -,---O I C-4--4- 1- o A-0
PROJECT DESCRIPTION
Detailed description of Iuork to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNERo
MAILING ADDRESS"
E-MAIL
301i0q /s r- 4v --
CITY STATE ZIP
r
FAX
—
PRIMARY PHONE
05- 77 SSS3
( NAME
r -,r C /N G.
MAILING ADDRESS
EMAIL
ELECTRICAL
70 g. 2 z o T,0 3 T
CITY STATE
//
/e Ew r- 141 /t
I ZIP
g15 O 3 2
CONTRACTOR
FAX
( -7-53 8'12- l 1 'Z
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
59Ar.4,F X- 0f7 7 Pw i2,, /ear
i0-02-- too 37(0-00-B
NAME
PRIMARY PHONE
APPLICANT
4A/ `'"' S
F( )
MAILING ADDRESS
ci _O✓�
E-MAIL
CITY
j STATE
ZIP
FAX
( )
PROJECT CONTACT
NAME A� Sh
PRIMARY PHONE
'7316L
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 rift part of this application.
SIGNATURE: DAT)6
PRINT NAME __ yes. �.✓--._ d i._._ _.._ _ �7���
Bulletin #100 January 1, 2013 Page I of 2 kAHandouls0coricai Permit Application