18-102112Electrical
CumtyD Development
Permit #:18-102112-00-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: HABTOM
Project Address: 2217 S 284TH ST Parcel Number: 422220 0330
Project Description: Install 100 amp service
Owner
Applicant
Contractor
TEFSA HABTOM
D S ELECTRIC CO
D S ELECTRIC CO
2217 S 284TH ST
25804 34TH AVE S
DSELE**0880T (9/30/18)
FEDERAL WAY WA 98003
KENT WA 98032
25804 34TH AVE S
USA
USA
KENT WA 98032
USA
Is this an Online or O.T.C. application? .................. Yes
Alt. Serv./Feeder: 0 to 200 aml
PERMIT EXPIRES Friday, 17 May, 2019
Permit Issued on Thursday, May 17, 2018
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 agen : Q� Date: 2— t9 a
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RECEIVED ELEC'T'RICAL
MAY 17 2018 PERMIT APPLICATION
CITY OF FEDERAL WAY I Q 1 0 21 (2- CO
COMMUNITY DEVELOPMENTPERMIT NUMBER (,
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SITE ADDRESS: � 1 � � � � t1�r , #'-
SUITE/UNIT/SPACE#
PROJECT VALUATION
A3SF�SSO� AX/PARC i. x Z_�
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CURRENT/PROPOSED USE
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PROJECT NAME
ro-
(Tenant or Homeowner Last Name)
N
PROJECTDESCRIPTION
Detailed description of work to
be included on this permit only
NAME ,- _ Q �,,
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o, PRIMARY PHONE
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d �l� 5 32
PROPERTY OWNER
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MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME At
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PHONE
O lP PRIMARY 1 q 10— f 1
MAILING ADDRESS pg�O
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E-MAIL
ELECTRICAL
DLI l'�1
CITY !
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME � n/
PRIMARY PHONE
APPLICANT
MAILING ADDRESS�/
E-MAIL
I- b 0 � -1 �
CITY
STATE
ZIP (70� �
FAX
PROJECT CONTACT
NAME
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PRIMARY PHONE
I certify under penalty of perfury 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 fcpplication.
SIGNATURE:\
PRINT NAME: 7L�14 D� F4 or
TE _9
Bulletin 4160 -April 14, 2016 Page 1 of I k:AHandouts\Electrical Permit Application