14-101956s
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
' FILE
Project Name: LAKE GENEVA GOLD
Project Address: 30380 30TH AVE SW
Project Description: Installing a new u/g pole
9
1
Electrical
Permit #: 14 -101956 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 416660 0476
Owner
Annlicant
Contractor
LAKE GENEVA GOLD
MODERN WIRING INC
MODERN WIRING INC
19221 36TH AVE W SUITE 204
11102 25TH AVE E SUITE C
MODERWI91 IKK (5113115)
LYNNWOOD WA 98036
TACOMA WA 98445
11102 25TH AVE E SUITE C
TACOMA WA 98445
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Temp. Service: 61- 100 amps (Res 1
PERMIT EXPIRES Monday, October 27, 2014
Permit Issued on Wednesday, April 30, 2014
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: Date: Cfl�b %
��Nq�FO
4 • THIS CARD IS TO MAIN ON-SITE t '
CITY OF Construction In ection Record
Federal Way INSPECTION REQ TS: (253) 835-3050
PERMIT #: 14 -101956 -00 -EL Address: 30380 30TH AVE SW
Project: LAKE GENEVA GOLD FEDERAL WAY, WA 98023
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
Approved
By Date
Approved
Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
0 i
CITY OF ELECTRICAL
Federal Way PERMIT A ATION
PERMrr Num$ER , _ S y _ ;-) !APR 3 0 2014
CITY OF FEDERAL WAY
SITE ADDRESS: � d 5� 36 ��i �LtJ
SUITE/UNIT/SPACE #
PROJECT VALUATION
R'S TAX/PARCEL # –
CURRENT/PROPOSED USE
PROJECT NAME
f7enant or Homeowner Last Name,
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAII.
CITY
STATE
ZIP
( FAX
t
ELECTRICAL
CONTRACTOR
NAME
Cjte,�
PRIMARY PHONE
MAILING ADDRESS
FIMAIL
CITY
�rt CU✓�-�
STATE
ZIP
FAx
WA' ^STATnE CONTRACTOR'S LICENSE # EXPIRjATION DATE G
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME --}—
1
l V n n Yw 1 y�
' L
PRIMARY PHONE
MAILING ADDRESS`
_
')-S M t
S�� C
E-MAIL
CITY
STATE
ZIP
FAX
PROJECTPHONE
PROJECT CONTACT
NAME
� � ylti �
12� -1 _ I o Y
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 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: ' / f_-2 DATE " / h6l I '7
PRINT NAME: �v
Bulletin # 160 —January 1, 2013 Page I of 2 LfflandoutsTlectrical Permit Application