15-104140�' • Electrical
City of Federal Way •
Community s Econ. Dev. Services Permit #: 15 -104140 -00 -EL
33325 8th Ave S
Federal Way, WA 98003 1 Ph: (253) 835-2607 Fa)c (253) 835-2609 Inspection Request Line: (2
53) 835-3050
r
Project Name: PEDERSON
Project Address: 31232 12TH AVE SW Parcel Number: 416800 0050
Project Description: Electrical service change.
Owner
ARRI11cant
Contractor
JUSTIN PEDERSON
LEBBERN ELECTRIC
LEBBERN ELECTRIC
3123212TH AVE SW
9704 181ST AVE E
LEBBEE" 936P9 (10/29/15)
FEDERAL WAY WA 98023
BONNEY LAKE WA 98391
9704 181ST AVE E
BONNEY LAKE WA 98391
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, February 13, 2016
Permit Issued on Monday, August 17, 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
,,--I n - the City of Federal Way.
Owner or
L J`
Date: $ v::"
CITY OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REW ON-SITE or
Construction Inspe tion Record
INSPECTION REQUESTS: (253) 835-3050
15 -104140 -00 -EL Address: 31232 12TH AVE SW
JUSTIN PEDERSON FEDERAL WAY, WA 98023-4503
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.
UFER Ground (4295)Ditch
cover (4030)
Temporary Power (4275)Service
Slab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
Temporary Power (4275)Service
1:1Approved
(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
Fin lectrical (4055)
Approved
B
L11- Date 6i J l
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
WCEIVED
CITY OF vls 0112.015 EC'T'RICAL
Federal WayAu
CM OF C®�RgLWA`� PERMIT APPLICATION
PERMIT NumBER
SITE ADDRESS: � �
01
SUITE/UNIT/SPACE
PROJECT VALUATION
vo
ASSESSOR'S TAR/PARCEL 0
---Yz:;4 __� _(R// �� V
o -
o C)
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
uG
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
"r` r
PRIMARY PHONE
(2 ) -
ING ADDRESS
3:1232, 12A AV 5 5. w,
F KAU.
CITY
F w
STATE
wa
ZIP
FAX
) -
CONTRACTOR
NAME
r. eLw—xr—; C,
PRIMARY PHONE
R -3
MAryHd^�!NG ADDRESS
� TAVE
E-MAIL-MAELECTRICAL
FAX
CITY
STATE
ZIP q
WA NTRACTOR'S LICENSE @ EXPIRATION DATE
P
FEDERAL WAY BUSINESS LICENSE @
APPLICANT
NAME
3
PRIMARY PHONE
46
MAILING ADDRESS
E-MAU.
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
) 1 _
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
alt 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 cla{n#, 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 of and employees, upon the accuracy of the
information suppliea� city as apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin # 160 —January 1, 2013 Pagel of 2 k:\Handouts\Electrical Permit Application