14-100659 •
• • Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 14-100659-00-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: TICHY
Project Address: 1023 S 295TH PL Parcel Number: 515180 0030
Project Description: 0-200 amp panel change and new wiring for grinder pump
Owner Applicant Contractor
ROBERT TICHY ROBERT TICHY OWNER IS CONTRACTOR
DIANE TICHY 1023 S 295TH PL
1023 S 295TH PL FEDERAL WAY WA 98003-3716
FEDERAL WAY WA 98003-3716
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
CONDITIONS:
Inspection approval is required prior to covering or concealing any portion of the septic electrical system,
including the pump. New septic& effluent tanks containing electrical wires and equipment MUST be
inspection and approved PRIOR to being loaded with sewage. (Per 296-46B-501-001(b)(7)WAC)
PERMIT EXPIRES Sunday, August 10, 2014
Permit Issued on Tuesday, February 11, 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 inaccordance with the laws, rules and regulations of the State of Washington
nd the City of Federal Way.
Owner or agent: ' a
Date: Z 1 L/—.
FINALED
< �`. ' THIS CARD IS TO ' 'MAIN ON-SITE
crrr 0 F �� Construction In ection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 14-100659-00-EL Address: 1023 S 295TH PL
Project: ROBERT TICHY FEDERAL WAY, WA 98003-3716
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) ID Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) ❑ Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By V"io Date 2,1 1.0[ vit
0 Feeders/Sub-panels(4045) El Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date j Date•._ 1 e,-fel By Date
El Final-Electrical(4055) 1
Approved
jtv 1 ,.'_ c Date-2 -2 V
El Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
.
•
• •
CITY OF ELECTRICAL
Federal Way PERMIT APPLICATION
PERMIT NUMBER 1� - A 0 0 - _
RECER
FEB 112014
SITE ADDRESS: arin&F E) L WAY
`U� � � �` 2Giy1 SCJ CD4
PROJECT VALUATION ASSESSOWS TAX/PARCEL N CURRENT/PROPOSED USE
$ 5 O;s), -
PROJECT NAME
(Tenant or Homeowner Last Name) /ecJ eV! 6/1,1141e, to � � `i�Y rsv1C 4
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER KC1SC/4e f GG2 c-
MAILING ADDRESS E-MAIL
0 7,3 "
CITY //pSTATE ZIP
eeel ke/ ( ., C' '! FAX
NAME
PRIMARY PHONE
GCI 6Z(ate ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP
FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME
PRIMARY PHONE
APPLICANT (16C (�-f % ( ) -
MAILING ADDRESS
E-MAIL
CITY STATE ZIP FAX
NAME )PRIMARY PHONE
PROJECT CONTACT
'' ( ` c`l (7S9) 6(0617
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.
41-7/7.
SIGNATURE: /24DATE -2_( i t 14--
PRINT NAME:
LID e "1 s ch
Bulletin#160—January I,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application