16-101121 I . Electrical .
cni»yty b Eof FCon.aereiDev.Swayervices
Permit #: 16-101121-00-EL
Commu
33325 8th Ave S
Federal why,Fax
� a 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Pax:(253)835-2609
Project Name: GODDARD
Project Address: 612 S 304TH ST Parcel Number: 064300 0320
Project Description: Replace electrical panel
Owner Applicant Contractor
THOMAS E PARTON MYRA J GODDARD OWNER IS CONTRACTOR
MYRA J GODDARD 612 S 304TH ST
612 S 304TH ST FEDERAL WAY WA 98003-4097
FEDERAL WAY WA 98003-4097
Additional Permit Information
Electrical Work Valuation 1500 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 Saturday, March 4, 2017
Permit Issued on Friday, March 4, 2016
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: I Date: ✓g
et)
floxl-
r
•
0 THIS CARD IS TO IN ON-SITE ,.
Federal In ection Record
Federal Way INSPECTION REQU TS: (253)835-3050
PERMIT#: 16-101121-00-EL Address: 612 S 304TH ST
Project: THOMAS E PARTON FEDERAL WAY, WA 98003-4097
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.
0 LIFER Ground (4295) El Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
ID Pool Bonding(4195) ❑ Temporary Power(4275) 13Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055) '
Approved
By 1146, Date 4 114S( (i. .
❑ Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
• RECEIVED
CITY OF � E 2016 CTRICAL
MAR 0 4
Federal Way PERMIT APPLICATION
CITY OF FEDERAL WAY
PERMIT NUMBER ) 0I
CDS.
L
-
SUITE/UNIT/SPACE#
SITE ADDRESS: ( ,/' ,f", 3 0 y 577--
PROJECT VALUATION `� ASSESSOR'S TAX/PARCEL# O` CURRENT/PROPOSED USE
$ Iso id .-- 0 4/ 3 v - U IQ, 0 I
PROJECT NAME / //n .��c
(Tenant or Homeowner Last Name) `7 /�/.,d J 4 ULb' W!
..G_F�7-/z.I c- I"',e4N,G G. , -1'''7`
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER in y .7-. ‘.0.d p,4../j ( ) 4/F-- b /q
MAILING ADDRESS E-MAIL
2 , s 62 Y.1 -'$-r"---
: /,Y` 7_ 3
CITY STATE ZIP FAX
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NAME PRIMARY PHONE
/1/Q ti€ ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME y� PRIMARY PHONE
APPLICANT
41 /041"! �'.b � a c6 )/j If- ,j-31c7
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX /��-;eg-�/� 4.'4WA' 9,03 ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT 476,0 �0 04),40.1) ( 4,.. ), /i f3 .1V
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 Iaws 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 thiss a/pplliiccattii�on. [�
t--)12/1-4
SIGNATURE: /"�'%I'�vl-'" " DATE 3-17,/
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PRINT NAME:i, • C/aye.)/ '
Bulletin#160-January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Applicatioi