15-103889e ClW of Federal Way
Community &Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
P4(253) 835-2607 Fax: (253) 835-2609
Project Name: ANDERSON
Project Address: 721 S 304TH ST
Project Description: Panel upgrade.
0
- lUectrical
Permit #: 15 -103889 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 232950 0170
Owner
ARDlican
Contractor
ROBERT ANDERSON
NICHOLSON ELECTRIC CO
NICHOLSON ELECTRIC CO
29201 20TH AVE S
PO BOX 365 ST
NICHOEC887CI (3/8/16)
FEDERAL WAY WA 98003
SEAHURST WA 98062
PO BOX 365 ST
SEAHURST WA 98062
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Electrical Fixtures
Alt. Serv./Feeder: 0 to 200 amps (F 1
Is Use Educational or Institutional?.......................No
PERMIT EXPIRES Monday, February 1, 2016
Permit Issued on Wednesday, August 5, 2015
I hereby certify that he abov information is correct and that the construction on the above described property and
the occupancy nd the use II b accordance with the laws, rules and regulations of the State of Washington
✓ and the City of Federal Way.
Owner or agent: Date:
CITY OF 40"Iftt�
Federal Way
PERMIT #:
Project:
THIS CARD IS TO RE ON-SITE -
Construction Insp ion Record
INSPECTION REQUESTS: (253) 835-3050
15 -103889 -00 -EL Address: 721 S 304TH ST
ROBERT ANDERSON FEDERAL WAY, WA 98003-4019
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.
Feeders/Sub-panels (4045) ❑ Rough Electrical (4225)
Approved Approved
By Date By Date
Final - Electrical (4055)
Approved
Date [�
0 Ceiling Cover (4020)
Approved
By Date
0
UFER Ground (4295)Ditch
cover (4030)
❑
Slab/Concrete Floor (4255)
E]
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045) ❑ Rough Electrical (4225)
Approved Approved
By Date By Date
Final - Electrical (4055)
Approved
Date [�
0 Ceiling Cover (4020)
Approved
By Date
0
Pool Bonding (4195)
Temporary Power (4275)
E]
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045) ❑ Rough Electrical (4225)
Approved Approved
By Date By Date
Final - Electrical (4055)
Approved
Date [�
0 Ceiling Cover (4020)
Approved
By Date
0
Rough Electrical
Approved
Final Electrical
Approved
E]
Right of Way
Approved
By
Date
By
Date
By
Date
OZECEIVED
CITY OF AAUG Q 5 2015 LECTRICAL
.Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER _Z 57
_ -6— 0 _
SITE ADDRESS:
ol-)
� 3 L� � S i
SUITE/UNIT/SPACE#
PROJECT VALUATION
$ , Pn
ASSESSOR'S TAX/PARC #
�� � 7 ---V -
7
0
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
t
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
7�
—
PROPERTY OWNER
NAME
PRIMARY PHONE
( ) -
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
S L
L°
PRIMARY PHONE
) -
MAILING ADDRESS
_P Q, i 2JA
E-MAIL
dL x l L L11 -74t
CITY
STATE
ZIP
FAX
-
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
( )
MAILING ADDRESS
'
E-MAIL
CI�TYf
- BIZ id IL
S�T(jA�TjE
VVi�/
ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY 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 ho" less the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense o such claim), which may be made by any person, including the undersigned, and filed against the city,''
but only where such claim ari es out f reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the c' as a paof is application.
SIGNATURE:
PRINT NAME:
TE 6� S, Za-
Bulletin # 160 —January 1, 2013 Page 1 of 2 U landoutsTlectrical Permit Application