15-105836Project Name: POVERTY BAY
Project Address: 1108 S 322ND PL
0
1hecrical
Permit #: 15 -105836 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 150260 0040
Project Description: Install 60 amp circuit to new HVAC roof top and GFCI for Poverty Bay
Owner
Applican
City of Federal Way
LEAVITT LAND & INVESTMENT
Community & Econ. Dev. Services
A C ELECTRIC SERVICE INC
` 33325 8th Ave S
FILE
Federal Way, WA 98003
CEDAR CITY UT 84721
Ph: (253) 835-2607 Fax: (253) 835-2609
804 W MEEKER ST SUITE 102
Project Name: POVERTY BAY
Project Address: 1108 S 322ND PL
0
1hecrical
Permit #: 15 -105836 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 150260 0040
Project Description: Install 60 amp circuit to new HVAC roof top and GFCI for Poverty Bay
Owner
Applican
Contractor
LEAVITT LAND & INVESTMENT
KATIE ROSEMARY
A C ELECTRIC SERVICE INC
216 S 200 W
A C ELECTRIC SERVICE
ACELESI025DF (3/6/16)
CEDAR CITY UT 84721
804 W MEEKER ST SUITE 102
804 W MEEKER ST SUITE 102
KENT WA 98032
KENT WA 98032
Additional Permit Information
Electrical Work Valuation?...................................2500.00 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional? ....................... No Service greater than 999 Amps? ............................. No
Electrical Fixtures
Circuits - Commercial .................... 1
PERMIT EXPIRES Saturday, May 14, 2016
Permit Issued on Monday, November 16, 2015
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the us ill be in ac roance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: t u-
&4&0%
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Y
CITY OF
Federal Way
PERMIT #:
Project:
• THIS CARD IS TO REN& ON-SITE < -- -
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -105836 -00 -EL Address: 1108 S 322ND PL
LEAVITT LAND & INVESTMENT FEDERAL WAY, WA 98003-8472
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.
Final - Electrical (4055)
Approved
By Date
UFER Ground (4295)
El
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
E]
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
Temporary Power (4275)
E]
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
E]
Ceiling Cover (4020)
E]
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
PERMIT NUMBER
ELECTRICAL
PERMIT APPLIGAA
NOV 16 2015
CITY OF FEDERAL WAY
SITE ADDRESS: pOV
1
SUITE/UNIT/SPACE #
.
S . 1
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL #
CURRENT/PROPOSED USE
PROJECT NAME
dv J�
�,F,
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
r ='
Detailed description of work to
be included on this permit only
pPRIMARY
OV
PHONE
( ) -
PROPERTY OWNER
MAILING ADDRESS
1 Ecr3 S • 32-2..� P 1.
E-MAIL
CITY
STATE
IWA
ZIP
FAX
NAME
'F-�L Seer i cQ
PRIMARY PHONE
%-2--
52MAIIhG.
LING ADDRESS
MAILING
W. M :5±42 -
2CONTRACTOR
- ` E-MAIL
ELECTRICAL
CITY
STATE
tA�
ZIP
'180S2
FAX
(2 �U-
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
Pt c F -t -SSS. 0'2-1 F o3 /731 i Ili
FEDERAL WAY BUSINESS LICENSE #
110 - 5 , Cao .
NAME
� ` S - Y 1 ` C
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
V qA-
STATE
ZIP
CMD32-
FAX
( ) -
PROJECT CONTACT
NAME
I��Y1 '�
PRIMARY PHONE
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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 Pederal 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 Pederal 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 a' es o / of therliance of the city, including its officers and employees, upon the accuracy of the
information supplied to he y as a rt of application
SIGNATURE:
PRINT NAME:
)� S
DATE
Bulletin #160 - January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
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