16-104899§. -q' • . M
City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253) 835-2609
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Electrical
Permit #:16 -104899 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: CVS PHARMACY
Project Address: 33520 21ST AVE SW Parcel Number: 132103 9098
Project Description: Install new electrical wiring for fire security and CCTV alarm system
Owner
Applicant
Contractor
WASHINGTON CVS PHARMACY LLC
WHITE SECURITY SYSTEMS INC
WHITE SECURITY SYSTEMS INC
100 WEST MINISTER ST SUITE 1500
12617 108TH AVE NE
WMTESSO44JP (6/14/18)
PROVIDENCE RI 02903
ARLINGTON WA 98223
12617 108TH AVE NE
ARLINGTON WA 98223
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
Low Voltage - Other (Commel 1 Low Voltage - Fire Alarm (Co 1
PERMIT EXPIRES Friday, 6 October, 2017
Permit Issued on Thursdav, October 6, 2016
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 accor ante with the laws, rules and regulations of the State of
Washin the City of Federal Way.
Owner or agent: Date: IV
CUT OF
Federal way
PERMIT #: 16104899 00
TMS, CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
Address: 33520 21ST AVE SW
Project: WASHINGTON CVS PHARMACY L FEDERAL WAY WA 98023-2874
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)
F11
Ditch cover (4030)
El
Slab/Concrete Floor (4255)
Feedem'Sub-panels (4045)
UFER Ground (4295)
IBY
Ditch cover (4030)
By
Slab✓Concrete Floor (4255)
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
®
Temporary Power (4275)
®
Service (4235)
Feedem'Sub-panels (4045)
Pool Bonding (4195)
Rough Electrical (4225)
Temporary Power (4275)
By
Service (4235)
By
Date
By
Date
By
Date
0
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)®
Ceiling Cover (4020)
Feedem'Sub-panels (4045)
Right of Way
Rough Electrical (4225)
Ceiling Cover (4020)
By
Date
By
Date—'
Date
E9 Final - Electrical (4055)
Final - Electrical (4C 55)
By UW, Date I 23 11
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
113Y
Approved
By
Date
By
Date
Date
RECEIVED ELECTRICAL
OCT os 2016 PERMIT APPLICATION
CITY OF FEDERAL WAY I
CDS PERMIT NUMBER
10 4g9q--co
SITE ADDRESS: 5,��)2r
) 2JASUITE/UNIT/SPACE
N
PROJECT VALUATION
/3 aC."'c,
ASSESSOR'S TAX/PARCEL X
CURRENT/PROPOSED USE
$
PROJECT NAME
Homeowner Last Name)
(Tenant or
C`c
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
E-MAIL
MAILING ADDRESS
CITY STATE ZIP
FAX
NAMaE�
\
C
PRIMARY PHONE
( I '
MAILING ADDRESS
2111
_
E-MAIL
ELECTRICAL
I
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE
CTOR'S LICENSE M
EXPIRATION DATE
(C) ),q / lq
FEDERAL WAY BUSINESS LICENSE I
NAME
PRIMARY PHONE
APPLICANT
\
//
l )
MAILING ADDRESS
E -MAH.
CITY
STATE
ZIP
FAX
( )
PROJECT CONTACT
NAME
��
;
c- .
PHONE
(��) a 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 rvironmental 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 Suppe��1d�� Lthe ty a/s apart of this apppli�ccatiioon. /
SIGNATURE: �L �i.IV'� o
:� , l Y �`'L
L C Ic DATE
PRINT NAME:
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederaiway.com
Bulletin #160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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