15-105346City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003 FILL
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: BENSON
Project Address: 29914 4TH AVE SW
Project Description: Change out panel and meter to 200 -amp.
Electrical
Permit #: 15 -105346 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 720500 0160
Ownr
Applicant
Contractor
ANTHONY BENSON
SUPREME ELECTRIC
SUPREME ELECTRIC
29914 4TH AVE SW
PO BOX 786
SUPREEL94606 (9/26/16)
FEDERAL WAY WA 98023
MILTON WA 98354
PO BOX 786
MILTON WA 98354
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional?....................... No
Electrical Fixtures
Alt. Serv./Feeder: 0 to 200 amps (F 2
PERMIT EXPIRES S
Permit Issued on Tues
I hereby certify that the above information is correct ani
the occupancy and the use will be in a ordance with i
i- % and the City
Owner or agent:
i
tructio a described property and
and r f the State of Washington
ly.
tDate: d
Rn
Ic
02016
2015
CITY OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE ,
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -105346 -00 -EL Address: 29914 4TH AVE SW
ANTHONY BENSON FEDERAL WAY, WA
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 itis 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.
Final - Electrical (4055)
Approved
By Date
El
UFER Ground (4295)Ditch
cover (4030)
Power (4275)
Slab/Concrete Floor (4255)
E]Right
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
El
Pool Bonding (4195)Temporary
Power (4275)
E]Right
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
Date
By
Date
Final - Electrical (4055)
Approved
By Date
El
Rough Electrical
Approved
Final Electrical
Approved
E]Right
of Way
Approved
By
Date
By
Date
By
Date
r j
a 1
CITY OF Building Division
Federal Wayderal Eighth Avenue South
Federal Way, WA 98003-6325
vizt�L Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: 2-OAIt- _+ �'Avt. -'5 UJ • PERMIT#: IS- %0s346 - o - li!:�L
I > h4te/, 110• %4 (Q) - 45;xV'oUindS '51A,& k% 64f- _reVV jv%a+tal jKCjjyjdt e jI j
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,cape va �•_ frvnti &cln. 0+1AV, .
IF YOU HAVE QUESTIONS CALL V%AI~+ (253) 835- X23
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE -INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
to 2�
DATE
INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
CITY OF 'A
Federal Way
RECEIVED
OCT 2 0 2015
CITY OF FEDERAL. WAY
CDS
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER J 5_ / D S _ d Q
SITE ADDRESS' L' , ,
1 j � U �� �
SUITE/UNIT/SPACE #
, cLE_C,
PROJECT VALUATION
ASSESSOR'STAR/PARCEL #
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CURRENT/PROPOSED USE
I U
PROJECT NAME
(Tenant or Homeowner Last Name)
�. �' 1 S
PROJECT DESCRIPTION
C
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Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
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PRIMARY PHONE
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MAILING ADDRESS
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STATE
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ZIP
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FAX
NAME
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MAILING ADDRESS 1n_ _
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E-MAIL
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CITY
STATE
ZIP�j L(
FAX
CONTRACTOR
WAC ECONTgA� OR'S LICENSE # EXPIRATION DATE ,BUSINESSFEDERAL
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WAY BUSINESS LICENSE #
NAME _
PRIMARY PHONE
APPLICANT
MAILING S
CITY
STATE
ZIP
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PROJECT CONTACT
NAME�/
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PRIMARY PHONE
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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 mad erson, including the undersigned, and filed against the city,
but only where such claim arises out of the re the city, inludin-b, its officers and employees, upon the accuracy of the
information supplied to the city as a p s cation.
SIGNATURE: DATE
PRINT NAME: IN ` C% C-7 O "Zb LL -11
Bulletin # 160 — January 1, 2013 Page 1 of 2 k:\F3andouts\Electrical Permit Application