13-101096 Electrical
City of FeWay Permit #: 13-101096-00-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: HALBERG
Project Address: 33453 33RD PL S Parcel Number: 614360 0365
Project Description: Extend(1)circuit for Gate control
Owner Applicant Contractor
JOHN R HALBERG MICHAEL HOFMANN HI AMP ELECTRIC
33453 33RD PL S HI AMP ELECTRIC HIAMPAE942DM(3/14/14)
FEDERAL WAY WA 98001-9647 31919 TISCH BOX 196 RD S PO BOX 196
ROY WA 98580 ROY WA 98580
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 Tuesday, September 3, 2013
Permit Issued on Thursday, March 7, 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 ,e City of Federal Way.
Owner or agent: / Date: . ' 7 `.,
%its_ • THIS CARD IS TO FMAIN ON-SITE
CITY OF �. Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 13-101096-00-EL Address: 33453 33RD PL S
Project: JOHN R HALBERG FEDERAL WAY, WA 98001-9647
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.
❑ UFER Ground (4295) Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date ByDate By Date
A . 3-it _13 .
❑ Pool Bonding(4195) ❑ Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
❑ Feeders/Sub-panels(4045) El Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
O Final-Electrical(4055)
Approved
By �. Date 7)_,1l-t --,,
•
Rough Electrical Final Electrical I=1Right of Way
❑ Approved I=1Approved Approved
By Date By Date By Date
• ELECTRICAL
- .
Federal Way PERMIT APPLICATION
(2 RECEIVED
PERMIT NUMBER ( 9 - 1 ( 0 C C _ O C MAR 0 7 2013
sVaftritrfgplithiipotL WAY
SITE ADDRESS: 3 3 q 53 3 3 0 p t so a - (Ally
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# R
CURENT/PROPOSED USE
coVC
$ t 4 3 (0 a - d 5
PROJECT NAME j� {,�
(Tenant or Homeowner Last Name) l1 3
PROJECT DESCRIPTION -1 ) (\l\ - r-O E c IQ C-01\}-1rD ,
Detailed description of work to
be included on this permit only
NAME .. PRIMARY PHONE
PROPERTY OWNER T dk YJ I- 1 BarC/ (: D(..)) C)47- L) Cry
MAILING ADDRESS ^ E-MAIL
33LI 5`3 3 "1:11I S
CITY, STATE ZIP FAX
1-e Der19 I l ( ) -
NAME \ PRIMARY PHONE
H 'el C UF-r-, (360) Yom- a-3 -2-.
MAILING itDDRESS J-% g
ELECTRICAL ilPy
V (i9 Thl(,4'4t/ei i tiff ded� tir(�• tui
CONTRACTOR CITY (21,\ STATE ZIP ci s,islio FAX
WA STATE CO CTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
( ) _
PROJECT CONTACT NAME 1/1 1 L.,1 1,V/ 1 /-t;1 44 ,Alp.) PRIID1?)tyt -PH'E
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.
i
7/
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SIGNATURE: q#421-1-c)-----11/ DATE / S
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Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application