13-101110 ELECTRICAL
CITY OF ''
Federal Way PERMIT APPLICATION
RECEIVED
PERMIT NUMBER 13 - 1 C ( 1 10 _ 00 MAR 0 8 2013
etTY/O8 SAL WAY
SITE ADDRESS: . 0G 4' s\ I r ( 7 CDS
PROJECT ASSESSOR'S O O -S TAX/PARCEL# ^ O CURRENT/PROPOSED USE
PROJECT NAME r r 0-1 -1
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(Tenant or Homeowner Last Name) jfl 1
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 4r% re--Q 46:4. ( t)6 ) 3q7- 5 IL/z--
MAILING ADDRESS E-MAIL
3/y00 z7” --c.... SL) AI,4/c, 1 ,CI
CITY STATE ZIP F
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NAME PRIMARY PHONE
014.-.4-' ..{" ( ) - -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
. . .. NAME PRIMARY PHONE
APPLICANT OW X— ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
NAME/'l� PRIMARY PHONE
PROJECT CONTACT �ri-,Q gi_i -c.:<-7 ( ) 37/ - 5712--
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 Iocal, state, or federal Iaws 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 ap•of this ••• ation.
/ / 7
SIGNATURE: /l -- 400."--- - DATE / +g- 2-�/3
PRINT NAME: P .^ 14/CJ,
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
t_
Electrical
City of Federal way Permit #: 13 -101110 -00 -EL
Community 8 Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line: 2
Ph: (253) 835-2607 Fax (253) 835-2609 l�on eq 53) 835-3050
Project Name: HAICH
Project Address: 3024 SW 317TH PL Parcel Number. 438800 0300
Project Description: Adding/altering (1) circuit for new electric water install
PERMIT EXPIRES Wednesday,
Permit Issued on Friday, M
I hereby certify that the above information is correct and that the
the occupancy and the use will be in accordance with the laws,
Owner or agent:
k;
fto
3
on ffitabove described property and
uJAW of the State of Washington
Date: 3 _ g —2013
Owner
RICHARD M HAICH
31400 27TH AVE SW
FEDERAL WAY WA 98023-7814
ARolicant
RICHARD M HAICH
31400 27TH AVE SW
FEDERAL WAY WA 98023-7814
Contractor
OWNER IS CONTRACTOR
PERMIT EXPIRES Wednesday,
Permit Issued on Friday, M
I hereby certify that the above information is correct and that the
the occupancy and the use will be in accordance with the laws,
Owner or agent:
k;
fto
3
on ffitabove described property and
uJAW of the State of Washington
Date: 3 _ g —2013
• �r
crryO
Federal Way
THIS CARD IS TO REMAIN ON-SITE ,
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 13 -101110 -00 -EL Address: 3024 SW 317TH PL
Project: RICHARD M HATCH FEDERAL WAY, WA 98023-2217
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
LIFER Ground (4295)11
Ditch cover (4030)
Temporary Power (4275)
Slab/Concrete Floor (4255)
0
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
0 Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
0
Temporary Power (4275)
0
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
0
Feeders/Sub-panels (4045)
0
Rough Electrical (4225)
0
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
0 Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
a ,,•
CITY OF Building Division
33325 Eighth Avenue South
Federal Wa Federal Way, 98003-6325
y Phone 253-835-2607 Fax
253-835-2609
CORRECTION NOTICE
ADDRESS: `3 LA Ph 1'i .�. �, � PERMIT#:_ ? :) - l C�t t I i k!h, E—� L,
l tJ I~ P r..�
,
IF YOU HAVE QUESTIONS CALL
(253) 835- '-.�, Z=%)
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.
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
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