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Electrical
unity FederalWayPermit #:18 -102284 -00 -ETA
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: S 356TH 81 PAC HWY S
Project Address: Parcel Number: CITY WIDE
Project Description: 20amp 120V service for cable amplifier for Comcast cable.
Owner
Applicant
Contractor
CITY OF FEDERAL WAY
TRI COUNTY ELECTRICAL SERVICES
TRI COUNTY ELECTRICAL SERVICES
33325 8TH AVE S
LLC
LLC
FEDERAL WAY WA 98023
PO BOX 931
TRICOCE948DZ (3/14/20)
ANACORTES WA 98221
PO BOX 931
ANACORTES WA 98221
Additional'Permit Information
Is this an Online or O.T.C. application? .................. Yes
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Alt. Srvc Feeder 1
PERMIT EXPIRES Wednesday, 29 May, 2019
Permit Issued on Tuesday, May 29, 2018
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and th use will be in accordance with the laws, rules and regulations of the State of
Ing o and the City of Federal Way. [2—q
Owner or agent: Date:
f
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
18102284 00 Address:
CITY OF FEDERAL WAY
• 1 9
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.
1❑
UFER Ground (4295)
®
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
Service (4235)
Approved
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
®
Rough Electrical (4225)
Temporary Power (4275)
®
Service (4235)
Approved
Approved
Approved
Approved
By
Approved
By
Date
By
By
Date
By
Date
❑
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
El
Approved
Approved
Approved
By
Date
By
Date I
By
Date
Final - Electrical (4055)
Approved
�' S Date SAI-aAz-
Rough Electrical
Final Electrical
El
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
RECEIVED
ELECTRICAL
MAY 29 2018 PERMIT APPLICATION
QOM ' 0 Deo OPMEW
PERMIT NUMBER _ l 2 _ (/
SITE ADDRESS' S(Q 2-oSUITE/UNIT/SPACE
#
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL #
CURRENT/ PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
_
�% ' 3 5� L �} 4— :pf,, C_
Zo i 2,6 J ®L 23Cn- uue l
PROJECT DESCRIPTION
11A r0 Q t` "- G:6& -LAI) -
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
_C,o CCA 1C1 '1(
PRIMARY PHONE
( ) -
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
/ FAX
l )
NAME �_.
( I_ I CO w� -C- t- �iL
PRIMARY PHONE
L I Z_ l q 3
(���<_ ) -
MAILING ADDRESS
q-3
E-MAIL
ELECTRICAL
U (
l 12 1 CUch4 1:_c� i
CONTRACTOR
CIT
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
C--' C-0 C�C- 01 L{ 6 D Z dz✓ 5-� l 4
NAME �j
- i 1�1L_ 5 c'.0, �C
1
PRIMARY PHONE
( 3) 5 (- gi - 5 q 7O
APPLICANT
MAILING ADDRESS
E-MAIL
'n
�C., l 1, A P 1 L
CITY..
STATE
ZIP
FAX
PROJECT CONTACT
NAME
-L"T � -
PRIMARY PHONE
�) qt - qz�
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 tothe city a part f this -application.
SIGNATURE: DATE
PRINT NAME: -Z 1 A E3
Bulletin #160 —April 14, 2016 Pap
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