18-102481i
City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fa)c (253) 835-2609
Electrical
Permit*:18-102481-00-EL
Inspection Request Line: (253) 835-3050
Project Name: MARLENE'S MARKET
Project Address: 2565 S GATEWAY CENTER PL' Parcel Number: 092104 9137
Project Description: Adding (1) dedicated receptacle for show floor
Owner
Applicant
Contractor
AN S LLC
CHARLES DEAN ELECTRIC LLC
CHARLES DEAN ELECTRIC LLC
PO BOX 1941
28107 20TH AVE S
CHARLDE930LQ (6/18/19)
AUBURN WA 98071
FEDERAL, WAY WA 98003
28107 20TH AVE S
FEDERAL WAY WA 98003
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
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PERMIT EXPIRES Friday, 7 June, 2019
Permit Issued on Thursday, June 7, 2018
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: Date:
CITY OF
Federal Way
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18100622 00 Address: 2565 S GATEWAY CENTER PL
Project: ANS LLC FEDERAL WAY WA 98003
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.
t❑
Mechanical Rough -in (4165)
0
Gas Piping (4125)
El
Final - Mechanical (40657
0
Approved
Final Electrical.
Approved to release test
Approved
By
Date
By
Date
By
Date
0
El
0
Rough Electrical
Final Electrical.
Right of Way
Approved
Approved
Approved
By
Date
By 0
Date i
By
Date
RECEIVED
CITY OF
Federal Way JUN 0 7 2018
ELEC'T'RICAL
PERMIT APPLICATION
COMMUNIETYE DEVELOPMENT I v V CC)
PERMIT NUMBER
SITE ADDRESS: 2� (65 (� A'C��F� FED � uJ3
SUITE/UNIT/SPACE #
PROJECT
. VALUATION
ASSESSOR'S TAX/PARCEL # � � - � � 7
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
NAME
V- M
PRIMARY PHONE
) -
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
/ FAX
l )
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
MAILING ADDRESS
Z$ v Jry
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
L"
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
)
PROJECT CONTACT
NAME
1L,�f-V1r,
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 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 application.
SIGNATURE: i y DATE
PRINT NAME: 1 i LV 1 IJ 1. J 1 J In
Bulletin #160—April 14, 2016 Page 1 of I k:AHandouts\Electrical Permit Application