13-104791t t,
1
Electirical
City of Federal Way - Permit #: 13-104791=00-E
Community &Econ. Dev. Services
33325 8th Ave S -,
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection Request Line: (253) 835-3050
Project Name: YAGER I T95
Project Address: 30560 5TH AVE SW Parcel Number: 178890 0430
Project Description: Replace 200 -amp panel.
Owner
Applicant
Contractor
YAGER TRUST
A A AMERICAN ELECTRIC INC
A A AMERICAN ELECTRIC INC
PO BOX 1868
5619 MILWAUKEE AVE E
AAAMEAE913DC (3/3/15)
BELLEVUE WA 98009
PUYALLUP WA 98372
5619 MILWAUKEE AVE E
PUYALLUP WA 98372
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Alt. Serv./Feeder: 0 to 200 amps (F 1
PERMIT EXPIRES Saturday, April 26, 2014
Permit Issued on Monday, October 28, 2013
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, rales and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: , �) Date: 1 S "
�-IVI G�I -CGf
CITY OF
Federal Wad/
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE' '
Construction In ection Record
INSPECTION REQUE TS: (253) 835-3050
13 -104791 -00 -EL Address: 30560 5TH AVE SW
YAGER TRUST FEDERAL WAY, WA 98023-3914
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 2 1 U) 3
Rough Electrical Final Electrical Right of Way
Approved 1:1Approved Approved
By Date By Date By Date
UFER Ground (4295)-
Ditch cover (4030)
Power (4275)
Slab/Concrete Floor (4255)
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date 2 1 U) 3
Rough Electrical Final Electrical Right of Way
Approved 1:1Approved Approved
By Date By Date By Date
Pool Bonding (4195)Temporary
Power (4275)
Service (4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
❑
E
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date 2 1 U) 3
Rough Electrical Final Electrical Right of Way
Approved 1:1Approved Approved
By Date By Date By Date
RECEWED
ELIPCTRICAL
CITY OF OCT 2 8 2013
Federal Way CIPERMIT APPLICATION
TY OF FEDERAL WAY
CDS
PERMIT NUMBER 3_ 1 0 Y 7'? / _ 0 0
SITE ADDRESS:
SUITE/UNIT/SPACE i
PROJECT VALUATIONASS
'S TAA/P EL # 17 0 - 0 Cid%
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
c�
Q Q V
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
VR -
PROPERTY OWNER
NAME
aK Ger"
PRIMARY PHONE
j) `1.(,0(22 - 400-7
MAILING ADDMISS
E-MAIL
CITY 1
� 6 acJ-
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
MAILING ADDRESS
i, , k
E�ilAI,�
��C✓✓ t� f V
CITY
pig.
STATE
ZIP
q 13� i 7
FAX
) -
WA STATE CONTRACTOR'S LICENSE M EXPnZATION DATE
AAAKC 3."t) & 3 i3 X
FEDERAL WAY BUSINESS LICENSE 8
APPLICANT
NAME
PRIMARY PHONE
)
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
)
PROJECT CONTACT
NAME
PRIMARY PHONE
H )
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.
P®
SIGNATURE: _.:i i t��' ., DATE
PRINT NAME:
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application