13-100664► . I
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
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' Electrical
Permit #: 13 -100664 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: MARC -ANTHONY CHIROPRACTIC CLINIC
Project Address: 32812 PACIFIC HWY S Parcel Number: 797880 0020
Project Description: Adding/altering circuits for new electrical outlets
Owner
ARlicant
Contractor
MARC -ANTHONY CHIROPRACTIC CLINIC
MARC -ANTHONY CHIROPRACTIC CLINIC
OWNER IS CONTRACTOR
12811 8TH AVE W SUITE B103
12811 8TH AVE W SUITE B103
EVERETT WA 98204
EVERETT WA 98204
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional?....................... No
Service greater than 999 Amps? .............................No
Electrical Fixtures
Circuits - Commercial .................... 5
PERMIT EXPIRES Saturday, August 10, 2013
Permit Issued on Monday, February 11, 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 t City of Federal Way.
Owner or agent Date:
<1'
THIS CARD IS TOIN ON-SITE
�,n� Construction In reiion RecordFederal Way INSPECTION REQ (253) 835-3050
PERMIT #: 13 -100664 -00 -EL Address: 32812 PACIFIC HWY S
Project: MARC -ANTHONY CHIROPRACTIC FEDERAL WAY, WA 98003-6408
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)
Slab/Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
Temporary Power (4275)
Service (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
Date11 ..��
By
Date
E]
Final - Electrical (4055)
Approved
By C
Date
Rough Electrical
Approved1:1
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CRY OF
Federal Way
PERmrr NUMBER '
0 ELICTRICAI:
PERMIT APPbON
10066q-00
EB 11 2013
CITY OF FEDERAL WAY
SITE ADDRESS: 32,21 Cd w• A Wfj01270a)
SUITE/UNI CE #
PROJECT VALUATION
$
ASSESSOR'S TAX/PARCEL #CURRENT/PROPOSED
_ 00
USE
oA,cc
PROJECT NAME
(Tenant or Homeowner Last Name)
S A f AC E AN HA-F-1CA1? 1V CIPO CL( N tn--
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
1AcctvicaA WfICTI iO3takllt
PROPERTY OWNER
NAME(r' AIMC 1M! w
A n -t ho P• .Sara t 1&^ �� t �`
PRIMARY PHONE
(2,) (,) &J L/ - S 2 L
MAILING ADDRESS
IZ$11 ��lE w t g -103
E-MAIL
haC>tii.,ocli^ic C Aa). cvn
cm
F_ve.11
STATE
wA
Z@
FAX
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAMEr
A'7 O a V okf"'. ',
PRIMARY PHONE
(Za b )40q - Irno
MAMING ADDRESS
l l It L(, 9I J t A - F- N
E-MAIL
nn W"0 'A .L 4, 1. wn
CITY
V- IIC
STATE
WA
ZIP
°�$�3`�
FAX
(4j r) '� l I - aL3a
PROJECT CONTACT
NAME
Sc f
PRIMARY PHONE
(2, b) 44 - Su,D
Z certify under penalty of perjury that Z am the property owner or authorized agent of the property owner. Z 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.
Z 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: AIM--) 1) t- DATE
PRINT NAME: jk^ 4Y',O -j %>
Bulletin # 160 — January 1, 2013 Page 1 of 2 k_\Handouts\Electrical Permit Application