13-104450Co of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253) 835-2609
0 . -4 f ` " he"Ctrical
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Permit #: 13 -104450 -00 -EL
- C Inspection Request Line: (253) 835-3050
Project Name: HAGENSEN
Project Address: 29816 12TH AVE SW
Project Description: Installation of breaker for GFI to connect hot tub.
Parcel Number: 195460 0071
Owner
Alzplican
Contractor
THOMAS & ANN HAGENSEN
THOMAS & ANN HAGENSEN
OWNER IS CONTRACTOR
2981612TH AVE SW
2981612TH AVE SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C. application? ................. es Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Circuits - Residential ...................... 1
PERMIT EXPIRES Saturday, April 5, 2014
Permit Issued on Monday, October 7, 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, rules and regulations of the State of Washington
and th City of Federal Way.
Owner or agent Date:
y THIS CARD IS TO MAIN ON, . - . a
Crry OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 13 -104450 -00 -EL Address: 29816 12TH AVE SW
Project: THOMAS & ANN HAGENSEN FEDERAL WAY, WA 98023-3407
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
0
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
0
Pool Bonding (4195)
0
Temporary Power (4275)Service
1:1Approved
(4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
0
0
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
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
RECEIVE®
CITYOFELEC'T'RICAL
Federal WayocT o7 �o��
CITY OF FEDERAL WAY PERMIT APPLICATION
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PER�r Nummm 13 - 1 6! Y ,3 0- FL
SITE ADDRESS: ���j I✓ , IQ
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SUITE/UNIT/8PACE9
PROJECT VALUATION
iw
$60,
SSOR'���
ASSES TAR/PARCEL $
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CURRENT/PROPOSED USE
P OJECT NAME (Tenant or Homeow
ner Last Name)
AW50J
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
NAME ;I
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PRIMARY PHONE
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MAIEJNG ADD �ye
E-MAM
STATE
ZIP
F
ELECTRICAL
CONTRACTOR
NA�SE
PRIMARY PHONE
BLAMING ADDRESS
EMAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE ® EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME SAMtt S fto wI d t'/Vcl.
t PRIMARY PHONE
)
MAMING ADDRESS
E-MAIL
CITY
STATE I
ZIP
FAX
( )
PROJECT CONTACT
NAME
of4/
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 fincluding costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claimj, which may be made by any person, including the undersigned, and flied 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 apart of this application.
SIGNATURE:
PRINT NAME.
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:Mandouts\Electrical Permit Application