13-103112 1116,. ELECTRICAL
CITY OF "
Federal Way PERMIT APPLICATION
RECEIVED
I
PERMIT NUMBER I _ 1 0 _3 1 ) 2 _ co
111 - - - JUL 12 2013
SITE ADDRESS: 3t-'151 c 6113-- 44-4- CITY OFF /fr(�Q?ACE#
eoLiz--,0•A W.. -y t,./ cg - CDS
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# Q / CURRENT/PROPOSED USE
PROJECT NAME \A w _ C� I
(Tenant or Homeowner Last Name) �r G V`Y^� \ 9 �
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME 5 PRIMARY PHONE
PROPERTY OWNER 5e l` 1 ( ) -
MAILING ADDRESS 0 E-MAIL
CITY STATE ZIP FAX
( ) -
NAMEPRIMARY PHONE
C..9 5 t�#-. w�. (Has-) `f% 3 - z 677
MAILING ADDRESS E-MAIL
ELECTRICAL (,v rAA 5 a f„uCywnC,c*(;)PGS,t.""
CONTRACTOR CITY STATE ZIP FAX
(W2-5-)CI 11 - 2,12-\
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT P6--S 1\AA-, 1 1 vkC.. (/ oc)) (�I Z S)L%3 - Z b'7'?
MAILING ADDRESS E-MAIL
Gni uhr1Ocil (1(640v \
CITY STATEZIP FAX
�J p- (t1Z$` ) lei - Z,)2.l
PROJECT CONTACT NAME PRIMARY PHONE
�N Sc3 ( (0 )331 - 'n23
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 a part of this application.
allIPP170.11.1.' -SIGNATURE: _r �r�n / DATE 7 } 2
PRINT NAME: r 1�f'J_.crl ..cft—'
Bulletin#160—January 1,2013 Page 1 of 2 IcAliandoutsTlectrical Permit Application
f a
71 11 -�!=- Electrical
coCity & Federal Wa� F Permit #: 13 -103112 -00 -EL
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line:
Ph: (253) 835-2607 Fax: (253) 835-2609 peC eG (253) 835-3050
Project Name: ST FRANCIS HOSPITAL KITCHEN REMODEL
Project Address: 34515 91M AVE S Parcel Number: 7504510020
Project Description: Install new VAV box and relocated (1) T -stat for associated tenant improvement
Owner
AR12111cant
Contractor
JOHN ELSWICK
W P C S INTL INC SEA OP
W P C S INTL INC SEA OP
FRANCISCAN HEALTH SYSTEM -W
15241 NE 90TH ST
WPCSH1912MI (7/17/15)
1717 S "J" ST
REDMOND WA 98052
15241 NE 90TH ST
TACOMA WA 98405
REDMOND WA 98052
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
Thermostat ................................ 1
1
PERMIT EXPIRES Wednes , January 8, 2014
Permit Issued on F ' ay, July 12, 2013
1 hereby certify that the above informatior68 nd that the nstruction on the above described property and
the occupancy and the use will be in with the laws, s and regulations of the State of Washington
e City o e ay.
Owner or agent:
Date: 7—)-2--)5
Circ 00 4A' '
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
13 -103112 -00 -EL Address: 34515 9TH AVE S
JOHN ELSWICK FEDERAL WAY, WA 98003-6761
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.
Final - Electrical (4055)
Approved
By Date
LIFER Ground (4295)Ditch
cover (4030)
0
Slab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
Temporary Power (4275)13
1:1Approved
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Rough Electrical (4225)
0
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date rL — 1
By
Date 1 -,,-,Ls.
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date