15-103971tk0
r' City of Federal Way
c4 Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
11$'h: (253) 835-2607 Fax: (253) 835-2609
Project Name: BELLESSA
Project Address: 32811 4TH AVE SW
•
Electrical
Permit #: 15 -103971 -00 -EL
Inspection Request Line: (253) 835-3050
Project Description: Remove a wall mounted light and replace it with 4 can lights
Parcel Number: 926491 1090
Owner
Anolicant
Contractor
CLARK F BELLESSA
RYAN NORTON
OWNER IS CONTRACTOR
32811 4TH AVE SW
718 N GRIFFIN AVE UNIT 310
FEDERAL WAY WA 98023-5614
ENUMCLAW WA 98022
Additional Permit information
Is this an Online or O.T.C. application?.................Yes
Service greater than 999 Amps? .............................No
Electrical Fixtures
Circuits - Residential ...................... 1
Is Use Educational or Institutional?.......................No
PERMIT EXPIRES Saturday, February 6, 2016
Permit Issued on Monday, August 10, 2015
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: V1011 -5-
r
1011- -
`Fli�U P_ED
THIS CARD IS TO MAIN ON-SITE
Cl" OF
Construction In ection Record
Federal Way INSPECTION REQ TS: (253) 835-3050
PERMIT #: 15 -103971 -00 -EL Address: 32811 4TH AVE SW
Project: CLARK F BELLESSA FEDERAL WAY, WA 98023-5614
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.
LIFER Ground (4295)Ditch
cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
❑
Temporary Power (4275)
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
B
Dat
Rough Electrical
Approved
Final Electrical
Approved
Right of Way—�
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
PERMIT NUMBER ) 5 _ I
+� RECEIVED
E C'T'RICAL
AUG 10 2015 PERMIT APPLICATION
CITY OF FEDERAL WAY
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 thgcity as apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\IIandouts\Electrical Permit Application
SUITE/UNIT/SPACE #
SITE ADDRESS: '3-2-61(
PROJECT VALUATION
L-/ S
ASSESSOR'S TAX/PARCEL #
9 Z d
CURRENT/PROPOSED USE
9csz
PROJECT NAME
(Tenant or Homeowner Last Name)
eSS O`,
J
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
Ma -k- F.
PRIMARY PHONE
('ZS'3 ) 3 3 2- 4.tq 7
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
�I
S/T
(
l )
MAILING ADDRESS
E-MAIL
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
`AL2YQ
PRIMARY PHONE
) Ili 17
MAILING DRESS
E-MAIL
CITY
STATE
I ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
(lIZ ) - S�
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 thgcity as apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\IIandouts\Electrical Permit Application