18-103005Electrical
City of Federal WayPermit #:18 -103005 -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 F�ILE
Project Name: NGUYEN
Project Address: 28111 28TH AVE S Parcel Number: 231240 0040.
Project Description: Upgrade electrical panel from 100 to 200 -amp; 200 -amp service upgrade.
Owner
Applicant
Contractor
HAI NGUYEN
HAI NGUYEN
OWNER IS CONTRACTOR
2811.1 28TH AVE S
28111 28TH AVE S
FEDERAL WAY WA 98003-3389
FEDERAL WAY WA 98003-3389
AdditionalPermit Information
Is this an Online or O.T.C. application? .................. Yes
Alt. Serv./Feeder: 0 to 200 ami 1 Mast or Meter Repair (Resider. I
PERMIT EXPIRES Tuesday, 9 July, 2019
Permit Issued on Monday, July 9, 2018
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the se 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: -07/171
CITY CW
Federal Way
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18103005 00 Address: 2811128TH AVE S
Project: HAI NGUYEN 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 untilit 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.
®
UFER Ground (4295)
®
Ditch cover -(4030)
®
Slab/Concrete Floor (4255)
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
®
Temporary Power (4275)
®
Service (4235)
Approved
Approved
Approved
By
Date
By
Date
By Q_
Date R--:4_%{-1
0
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
Date
Rough Electrical
Final. Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
ELEC'T'RICAL
CITY OF �` J U L 0 9 2018
Federal Way CITY OFFEDERAL WAY PERMIT APPLICATION
COMMUNITY DEVELOPMENT
PERMIT NUMBER _ n O D - 6.0
SITE ADDRESS' � 2 2 9 / 1 V E .Jt }-(j! l z pgk L �a/ 502"'1SUITE/UNIT/SPACE
' I % / �
#
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL #CURRENT/PROPOSED
USE
PROJECT NAME
(Tenant or Homeowner Last Name)
N Ci U y N
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
'��114 A ew
PROPERTY OWNER
NAME
/ j-/ �- n/6 L) C --A)
PRIMARY PHONE
(M6) 4 34-- q6 08
MAILING ADDRESS f
A / d'
E-MAIL
CITY
�a1e��r W
STATEZIP
q ADD
FAX
c ) -
ELECTRICAL
CONTRACTOR
NAME
// PRIMARY PHONE
l )
MAILING KDDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
H tq-! AW S-1�
PRIMARY PHONE
) 4134a L G)S)
MAILING ADDRESSE-
�4 41VI Sr
L
CITY
STATEZIP
90
FAX
c ) -
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 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 whe such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information s plied to the city as aZ",
of this pplication.
SIGNATURE: DATE 0 0 cl /901
O
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Bulletin 4160 —April 14, 2016 Page 1 of I k:AHandouts\Electrical Permit Application