16-103548City of Federal WayJ7-
Community & Econ. Dev. Services Permit #. 16 -103548 -00 -EL
33325 8th Ave S
Federal way, WA 98003 " 253 Line: Request uest
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection q } 8 35-3050
Project Name: HAYNES
Project Address: 29834 10TH AVE SW
Project Description: Relocate existing mast
Parcel Number: 195460 0200
Owner
ApRlican
Contractor
BEN HAYNES
BEN HAYNES
OWNER IS CONTRACTOR
29834 LOTH AVE SW
29834 10TH AVE SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Electrical Work Valuation?....................................500.00 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No
Electrical Fixtures
Mast or Meter Repair (Residential/ 1
PERMIT EXPIRES Saturday, July 22, 2017
Permit Issued on Friday, July 22, 2016
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:
FINALED
., THIS CARD IS TO REMAIN ON-SITE
► i'
crm
1W �' Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) $35-3050
PERMIT #: 16 -103548 -00 -EL Address: 29834 10TH AVE SW
Project: BEN HAYNES FEDERAL WAY, WA 98023-8206
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
Pool Bonding (4195)
Approved
By Date
Temporary Power (4275)
Approved
By V4 Date -1
0
R Ground (4295)Ditch
cover ( 0)
Rough Electrical (4225)
Slab/Concrete Floor ( 5)
Approved
Approved
By
Approved
By
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
Approved
By Date
Temporary Power (4275)
Approved
By V4 Date -1
0
Feeders/Sub-panels (4045)
0
Rough Electrical (4225)
Date Q _9 _
Approved
Ceiling Cover (4020)
By
Approved
By
Date
Date
By
Date
0 Final - Electrical (4055)
Approved
Date .�
Service (4235)
Approved
C
Date Q _9 _
1:1Approved
Ceiling Cover (4020)
By
Approved
By
Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
CITY OF
Federal Way
ELEC'T'RICAL
RECEIVED PERMIT APPLICATION
JUL 2 2 2016 (� n
CITY OF FEDERAL WRMIT NUMBER l `v _ v _ ��
CDS
SITE ADDRESS'� GV �CQ le /�
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SUITE/UNIT/SPACE #
PROJECT VALUATION
A/SSESSOWS TAR/PARCEL
CURRENT/PROPOSED USE
PRCFJECT NAME
(Tenant or Homeowner Last Name)
e
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER-
NAME
PRIMARY PHONE
MAILI�NNG ADDRESS
E-MAIL
//7
1/ / Q ' t
CITYr
C/ r
STATE
ZIP
��
F
( ) -
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
( )
MAILING DRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
al _Z
Gc % P
PRIMARY PHONE
( ✓) -
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
( FAR
l )
PROJECT CONTACT
NAME /
�,1� /Wa
PRIMARY PHONE
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. �y
SIGNATURE: DATE �/ X;-
PRINT NAME:
Bulletin #160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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