13-103572 RECEIVED
CITY OF _. Au� 4 2013 ELECTRICAL
Federal Way C FEDERAL WAY PERMIT APPLICATION
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PERMIT NUMBER 3 _ / 0 3 5 7 ,_ . L
SITE ADDRESS: OV 9 8- (1 SUITE/UNIT/SPACE i
PROJECT VALUATION�j�7IASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME
(Tenant or Homeowner Last Name) ,61 /L Al S
PROJECT DESCRIPTION /4)/Zr//` 12-e2C1, A ci / 4c ,
Detailed description of work to /' �� C� ,7 s 1 &r /r ��� K 7/'
be included on this permit only J G/� ���ttt ��j�� /�tri�/y5/t
NAME
PRIMARY PHONE
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MAILING ADDRESS
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CITY STATE ZIP FAX
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NAME
PRIMARY PHONE
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CONTRACTOR CITY STATE ZIP
FAX
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WA STE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME
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PROJECT CONTACT NAME PRIMARY PHONE
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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.
SIGNATURE:
/
7 • / Xf1 DATE e/ �-
PRINT NAME: F /e4‘//-75(} l)
Bulletin#160—January 1,2013 Page 1 of 2 k:\I-Iandouts\Electrical Permit Application
Electrical
Cityof FeWay Permit #: 13-103572-00-EL
Community&Econ.on.Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609FILE
Inspection Request Line: (253)835-3050
Project Name: DELVES
Project Address: 2809 S 284TH ST Parcel Number: 730320 0020
Project Description: Electrical work for conversion of garage to bedrooms.
Owner Applicant Contractor
SAKISHA A DELVES CLIFF ROBINSON BURRIS ELECTRIC LLC
PO BOX 523 24906 38TH AVE S BURRIEL923DL(3/16/16)
KENT WA 98032 KENT WA 98032 14917 82ND AVE NW
GIG HARBOR WA 98329
•
Additional Permit Information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Electrical Fixtures
Alt.Serv./Feeder:0 to 200 amps(F 1
PERMIT EXPIRES Friday, October 17, 2014
Permit Issued on Wednesday,August 14, 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
a d the City of Federal Way.
Owner or agent: /,/ ,/ �,� - ig Date: 4 1 8-it-I'
ALE.1:11)
.��.{{ Electrical
City of Federalay
Community&Econ.Dev.Services Permit #: 13-103572-00-EL
33325 8th Ave S
Federal Way,WA 98003 Request InS ection
Ph:(253)835-2607 Fax:(253)835-2609 p q est Line: (253)835-3050
Project Name: DELVES
Project Address: 2809 S 284TH ST Parcel Number: 730320 0020
Project Description: Electrical work for conversion of garage to bedrooms.
Owner Applicant Contractor
SAKISHA A DELVES CLIFF ROBINSON BURRIS ELECTRIC LLC
PO BOX 523 24906 38TH AVE S BURRIEL923DL(3/16/14)
KENT WA 98032 KENT WA 98032 14917 82ND AVE NW
GIG HARBOR WA 98329
•
Additional Permit information
Is this an Online or O.T.C.application Yes Is Use Educational or Institutional? No
Electrical Fixtures
Alt.Serv./Feeder:0 to 200 amps(F 1
PERMIT EXPIRES Monday, February 10, 2014
Permit Issued on Wednesday, August 14, 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 the City of Federal Way.
Owner or agent: / T�-�- Date: V,97/�
4
THIS CARD IS TO REMAIN ON-SITE " `
Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 13-103572-00-EL Address: 2809 S 284TH ST
Project: SAKISHA A DELVES FEDERAL WAY, WA 98003-3315
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 UFER 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) El Service(4235)
Approved Approved Approved
By Date By Date By Date
% . .
El Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By 0
titt A- Date S 4.Q_1 Lt By Date
O Final-Electrical(4055)
Approved
By Utita Date $(L3 Ilk
O Rough Electrical Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date