13-103669M
City of Federal Way
Community 8 Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
FILE
Electrical
Permit #: 13 -103669 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: HEDGECOCK
Project Address: 29812 24TH AVE SW Parcel Number: 893750 0250
Project Description: REMOVE AND REPLACE LIGHTS AT FIREPLACE, REPLACE EXISTING SWITCH
LEG, RUN NEW SWITCH LEG, INSTALL 3 CAN LIGHTS, INSTALL STACK
SWITCH, INSTALL STACK SWITCH
Owner
Ap licant
Contractor
MAX HEDGECOCK
KIM MITCHELL
PROVIDENT ELECTRIC INC
ELIZABETH HEDGECOCK
PROVIDENT ELECTRIC INC
PROVIEI103C2 (2/22/14)
29812 24TH AVE SW
17615 SE 252ND ST
PO BOX 7087
FEDERAL WAY WA 98023
COVINGTON WA 98042
COVINGTON WA 98042
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Circuits - Residential ...................... 3
PERMIT EXPIRES Monday, February 17, 2014
Permit Issued on Wednesday, August 21, 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 the City of Federal Way.
Owner or agent alft ft a N oft a Date:
CITY OF 4A�
Federal Way
PERMIT #:
THIP) CARD IS TOIN ON-SITE
Construction Ins ction Record
INSPECTION REQUE TS: (253) 835-3050
13 -103669 -00 -EL Address: 29812 24TH AVE SW
Project: MAX HEDGECOCK FEDERAL WAY, WA 98023-2300
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 (429)
E]
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
E]
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
0
Pool Bonding (4195)
Temporary Power (4275)
E]
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Ceiling Cover (4020)
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
13 Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
RE��'�®
PERMIT APPLICATION
Federal Way
APR 15 2013
CiT`( OF FEDERAL WAY
PERMIT NIIMBER / 3 _ 42 TARGET DATE
SITE ADDRESS `
SUITE/UNIT #
(V -4 Uel j 1 pv 1T , ' , (55 3r: v2 S w
PROJECT VALUATf0k
ZONING
ASSESSOR'S TAR/PARCEL #
n
691 v
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME PRIMARY PHONE
&e "30 7 3q 76
{(�
Mpo AILING ADDRESS E- XAIL
d
6 V I I /,C� vS I c t �T�%'T/ L
CITY A STATE ZIP
'7 C e)
NAME
4 /Pli ag�j
MAILING RESS �MAII.
CONTRACTOR
CITY
STATE
ZIP PAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE #
NAME PRIMARY PHONE
APPLICANT
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRDL&RY PHONE
PROJECT CONTACT
MAILING ADDRESS WMAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP FAX
concerning this application)
PROJECT FINANCING
NAME ❑ OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
NAILING ADD ,CITY, STATE, ZIP PHONE
I certify under penalty of perjury that I am the property owner or authorised 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 apart of this application.
IS --13
SIGNATUN/./ � DATE 11—IS--13
PRINT NAME:
Bulletin #100 —January 1, 2013 Page] of 3 k:\Handouts\Permit Application
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