18-102425Electrical
unty Fedeopment Permit #:18 -102425 -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: CORMIER
Project Address: 1033 S 295TH PL Parcel Number: 515180 0025
Project Description:' Upgrade to 200A Panel.
Owner
Applicant
Contractor
SIMONE CORMIER
TED MEZGEBVTED ELECTRIC CO
TED ELECTRIC CO
1033 S 295TH PL
5906 S 144TH ST
TEDELEC925MQ (7/18/18)
FEDERAL WAY WA 98003
TUKWILA WA 98168
5906 S 144TH ST
TUKWILA WA 98168
Additional Permit Information
Is this an Online or O.T.C. application? ................. Yes
Alt. Serv./Feeder: 0 to 200 aml 1
PERMIT EXPIRES Tuesday, 4 June, 2019
Permit Issued on Monday, June 4, 2018
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the u 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: b 2t2
• P
Federal Way
TIIfS CART IS TO REMAIN ON-SITE
ConstructionInspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18102425 00 Address: 1033 S 295TH PL
Project: SIMONE CORNIER FEDERAL WAY WA 98003-3716
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.
0
LIFER Ground (4295)
®
Ditch cover (4030)
0
Slab/Concrete Floor (4255)
'
Approved
Final Electrical
Approved
Approved to place concrete
By
Date
By
Date
By
Date
®
Pool Bonding (4195)❑
®
Temporary Power (4275)
®
Service (4235)
'
Approved
Final Electrical
Approved
Approved
By
Date
By
Date
BY
Date
®
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
'
Approved
Final Electrical
Approved
Approved
By
Date
By
Date
By
Date
to Final - Electrical (4055)
Approved
By Date '.
'
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
RECEIVED
JUN, 0 4 2018
CITY OF FEDERAL WAY
GOMMUNITY DEVELOPMENT
ELECTRICAL
ftRMIT NumBER l g_ 1 C) 2 y 2 .-5" _ E &I
SITE ADDRESS:
SUITE/UNIT/SPACE #
6� L d a
O 9
PROJECT VALLUATION
ASSESSOR'S TAX/PARCEL #
CURRENT/PROPOSED USE
/I�
314(00.
J F- S.L..
!
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
S i NVQ I1 r IM., ex
( ) -
MAILING ADDRESS
E-MAIL
JV 33 S. Z 1� �•
CITY
STATE
ZIP
FAX
Fed er--a) w
IWA
I 98001
( a -
NAME
-re. d 6- le `c 0
PRIMARY PHONE
(cRO l G 3
MAILING ADDRESS
�r� 0 ( 4 4
EMAIL
ELECTRICAL
CONTRACTOR
CITY
'ToX-Wi
STATE
ZIP
'R (5) b$
FAX
( -
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
T ,D L C, i t I
NAME
PRIMARY PHONE
— to
k2a) bl
APPLICANT
MAILING ADDRESS
EMAIL
CITY
STATE
ZIP
}} FAX
( I
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 cert(fy 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 wheresuch claim arises ut of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci a part of this application.
SIGNATURE: 4 DATE 04/04)),o
PRINT NAME: �%'� /M 2 Zt e,4 I/.
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenteNu?cityotTederalway.com
Bulletin #160 — April 14, 2016 Page 1 of I k:�HandoutslElectrical Permit Application
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