17-102466 • h
Electrical
City of Federal Way Permit #:17-102466-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph (253)835-2607 Fax (253)835-2609
Project Name: DICKEY
Project Address: 30430 21ST AVE SW Parcel Number: 122103 9166
Project Description: Alteration of(1)circuit to add patio lighting.
•
Owner Applicant Contractor
ERIC DICKEY ERIC DICKEY OWNER IS CONTRACTOR
30430 21ST AVE SW 30430 21ST AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C.application? Yes
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Wednesday,23 May,2018
Permit Issued on Tuesday,May 23,2017
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: Date: � 3//7
rilt4JAIftED
THIS CARD IS TO REMAIN ON-SITE
CITY
°FConstruction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 17 102466 00 Address: 30430 21ST AVE SW
Project: LAURA DICKEY FEDERAL WAY WA 98023-2306
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.
or=
UFER Ground(4295) 0 Ditch cover(4030) CI Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
C Pool Bonding(4195) W Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
C Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
.By Date ByDate /L , , By Date
f
® Final-Electrical(4055)
Approved
gY- Dat 14 I iG'
CI Rough Electrical ❑ Final ElectricalCI Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
ELECTRICAL
CITY OF MAY 2 3 2017
Federal Way CITY OFFEDERAL WAY PERMIT APPLICATION
COMMUNITY DEVELOPMENT
PERMIT NUMBER // } _ / o y _
lto`-s SUITE/UNIT/SPACE#
SITE ADDRESS: 304-30 2(ST r NVE S LI) eaQ.rck tAfAci
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 2cx? / c3)-• - ( U 2 _ ( 6
PROJECT NAME
(Tenant or Homeowner Last Name) LACth-}; c J( 1`,r)
PROJECT DESCRIPTION adcl n5 '11 5 ex -rIor
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ALL (290 ) )(o - 92/0S
MAILING ADDRESS E-MAIL
X430 c7 e- G/141 Ls •CO/V‘
CITY STATE ZIP FAX
VeCtpr \ ,.w • ()CAv23 ) -
/N� ,�AMEPRIMARY PHONE
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 C /R e-r ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT ( )
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: Z� ( DATE 5/21 7
PRINT NAME: eR-I c- 7)1CXeh
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application