17-101994-- .3
4
Electrical
City of Federal Way Permit #:17 -101994 -00 -EL
Commmity Development Dept
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line: (253) 835-3050
Ph: (253) 835-2607 Fac (253) 8355-2609
Project Name: SAFEWAY
Project Address: 1207 S 320TH ST Parcel Number: 150050 0020
Project Description: Install new low voltage card readers to gas dispensers.
Owner
Applicant
Contractor
MGP IX SUNSET SQUARE LLC
ROBERT JACKMASCOTT EQUIPMENT CO
MASCOTT EQUIPMENT CO INC
425 CALIFORNIA ST FLOOR 11
INC
(ELECTRICAL)
SAN FRANCISCO CA 94104
6530 5TH PL S
MASCOEC957C8 (6/5/19)
SEATTLE WA 98108
435 NE HANCOCK ST
PORTLAND OR 97212
Additional Permit information
Is this an Online or O.T.C. application? .................. Yes
Low Voltage - Other (Commel 6
PERMIT EXPIRES Wednesday, 2 May, 2018
Permi sued on Tuesday, May 2, 2017
I hereby certify that the above Oformation is
and the occupancy and thq use will be in
Owner or agent:
[hat the construction on the above described property
with the laws, rules and regulations of the State of
ity of Federal Way.
Date: �� 1
J
GITY OR A!�A
Federal Way
THIS CARD IS TO REMAIN ON-SITE '
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERNIIT #: 17101994 00 Address: 1207 S 320TH ST
Project: MGP IX SUNSET SQUARE LLC FEDERAL WAY WA 98003-5339
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 loeeed on the hack of *hie Pam
®
UFER Ground (4295)
®
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
El
Approved
Approved
By
Approved to place concrete
By
f �
Date
1
By
Date
By
Date
U Pool Bonding (4195)
Approved
By Date
U Feeders/Sub-panels (4045)
Approved
By Date
90 Final - Electrical (4055)
Approved
By C Date q_ d
® Temporary Power (4275)
Approved
BV no*a
® Rough Electrical (4225)
Approved
By Date
®
Service (4235)
Approved
By
Date
El
Ceiling Cover (4020)
Approved
By
Date
❑
Rough Electrical
Approved
❑
Final ElectricalRi
❑
ht of Wa
g Y
Approved
Approved
By
Date
By
Date
By
Date
CITY OF /k�Z
Federal Way
RECEIVE®
MAY 0 2 2017
CITY
OF FEDERAL- WAY
O MUNTYEDEVELOPMENT
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER ( _ I c) 1 9 9 *_ !�:_ V
SITE ADDRESS: ®7
s, � � ®�( S�
SUITE/UNIT/SPACE #
PROJECT0
) VALUATION
/0-"
ASSESSOR'S TAR/PARCEL ® - ® ��
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
0
Detailed description of work to
be included on this permit only
NAME C �..,
PRIMARY PHONE
PROPERTY OWNER
-
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
( FAX
1 )
NAME � � � 9
PRIMARY PHONE
(.9s )6D-7
MAILING ADDRESS
L a- E ,
EMAIL
ELECTRICAL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
( )
MAILING ADORES
(0
Eby
CITY
STATE
V' A
ZIP
r� e7
L Sl L_�
FAR
FAX
( )
PROJECT CONTACT
NAS AAA
CJ -0 f
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 pe not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction ort onmental i S.
I further agr to hold harmle the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigati and defense of su claim), which maybe made by any person, including the undersigned, and filed against the city,
but only w such claim arises t of th$ reliance of the city, including its officers and employees, upon the accuracy of the
information pplied to the ci as a artof ftis application.
SIGNATURE:
PRINT NAME:
�.-Z — ( 1
Bulletin #160 —April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application