11-100934I,
City of Federal Way • 0 Electrical
Community Development Services Permit #. 11 -100934-0�0-EL
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: (253) 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: TEMPLO ALFA Y OMEGA CHURCH
Project Address: 2020 S 314TH ST Parcel Number: 092104 9053
Project Description: Installing IN wiring for new fire alarm system.
Owner
Applicant
Contractor
ROSEMARY CHAU
TEMPLO ALFA Y OMEGA
DONNIE TUCKER
11912ND AVE #18TH
810 SW 307TH ST
TUCKNDB962LN (8/31/13)
SEATTLE WA
FEDERAL WAY WA 98023
PO BOX 239
98101-3438
BUCKLEY WA 98332
Is Use Educational or Institutional? ....................... No Service greater than 999 Amps? ............................. No
se
Low Voltage - Fire Alarm (Comm( 1
PERMIT EXPIRES Thursday, March 8, 2012
I hereby t
the occu
Owner or agent:
will be in
the ON of
1
he above described property and
ions of the State of Washington
Date:
CITY OF 4A�p
Feiddral Way
THIS CARD IS TO MAIN ON-SITE
Construction I ection Record
INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 11 -100934 -00 -EL Address: 2020 S 314TH ST
Project: ROSEMARY CHAU FEDERAL WAY, WA 98003-5475
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.
Rough Electrical (4225)
Ceiling Cover (4020)
Final - Electrical (4055)
Approved
Approved
Approved
ByP , Date ^ , t, _ `
i
By `� � Date W `
�S Date 3
Rough Electrical
Approved
Final Electrical
Approved
Right of Way -^
Approved
By
Date
By
Date
By
Date
1.- 4�k --•
CITY OF
Fed - .. \/LECTRICAL
MAR q 9 PERMIT APPLICATION
A� W AY
icaI hermits may be obtained on-line at www. citvoffederalway.com
SITE ADDRESS: ] t (
CITY
��. l a �
SUITE/UNIT/SPACE #
ASSESSOR'S TAX/PARCEL #
NAME �
yy
l ��
CURRE T/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
r
PROJECT DESCRIPTION l
Detailed description of work to r
be included on this permit only A ti
PROPERTY OWNER
NAME
MAILING ADDRESS
PRIMARY PHONE
E-MAIL
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. 1 understand that the
issuance of this peoes not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or envi nmen al laws.
I further agree ! hold h less the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation an defen a of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where suc ciaifi arises out the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied o the' as a part this application. q
SIGNATURE: - DATE I
PRINT NAME
33325 8"' Avenue South ♦ Federal Way # WA 1 98003-6325 ♦ 253-835-2607 1 fax: 253-835-2609 ♦ www-cityoffederalway.com
Bulletin # 160 --January 1, 2011 Page 1 of 2 k:\Handouts\Electrical Permit Application
CITY
STATE
ZIP
FAX
NAME �
yy
l ��
PRI MARY PHONE
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MAILING ADDRFtSS �,., f` +/�
CJ\`
E-MAIL
ELECTRICAL
t`)J V
CITY
�r�
STATE
ZIP(
�-
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
h
PRIMARY PHONE
5. , -
APPLICANT
MAILING ADbkRESS
E-MAIL
ZIP
( FAX
PROJECT CONTACT
N EPRIMARY
C7 �- a
PHONE
,rid'{ t 2.., 1
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. 1 understand that the
issuance of this peoes not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or envi nmen al laws.
I further agree ! hold h less the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation an defen a of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where suc ciaifi arises out the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied o the' as a part this application. q
SIGNATURE: - DATE I
PRINT NAME
33325 8"' Avenue South ♦ Federal Way # WA 1 98003-6325 ♦ 253-835-2607 1 fax: 253-835-2609 ♦ www-cityoffederalway.com
Bulletin # 160 --January 1, 2011 Page 1 of 2 k:\Handouts\Electrical Permit Application
Fear l Wof ECEIVE* PERMIT
COMMUNITY25 83 6DEELOPMENT 07- FAX 253-835ER609i 9 201A p PLICATION
wu_u,ri? rlgjferernluxz�t..rr�m
CITY OF FEDERAL WAY
MF CO ME PL DE EN FP
cam( U/ 0 -r:-1/*
SITE ADDRESS
J
��� CESG �� �
SUITE/UNIT #
PROJECT VALUATION
N. ioo
ZONING
ASSESSOR'S TAX/PARCEL #
Q- 2-- O 14_ C S
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
vA /1E11PLDAtM0f1X�+
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
i
MAILING ADDRESS
E-MAIL
CITY STATE ZIP
NAME
.��' R
PHONE
MAILING ADDR S
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
Nom--
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY STATE ZIP C�
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAMF,�
0%-,"i 'fl` C''5c ®
PHONE _
a `T b y
MAILING ADDRESS
o v u
E-MAIL
CITYSTATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
aan 6 '(a�
E-MAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 apart of this application.
SIGNATURE: 1 DATE aCl K1CJ a01
PRINT NAME: Ch wt
Bulletin #100 —January 1, 2011 _ Page 1 of 3 k:\Handouts\Permit Application