14-1050821
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
w
Electrical
Permit #: 14 -105082 -00 -EL
FILL Inspection Request Line: (253) 835-3050
Project Name: FRED MEYER
Project Address: 33702 21ST AVE SW Parcel Number: 930100 0010
Project Description: Adding /altering up to (12) circuits for retrofit all existing refrigerated cases in deli, bakery,
produce and beverage areas
Owner
ARolicant
Contractor
FRED MEYER INC
C J ELECTRICAL SUPPLY & SVCS LLC
C J ELECTRICAL SUPPLY & SVCS LLC
PO BOX 42121
21817 88TH PL S
CJELEES966M7 (10/23/14)
PORTLAND OR 97242
KENT WA 98031
21817 88TH PL S
KENT WA 98031
PERMIT EXPIRES M140ray, M9015
Permit Issued on sday, 0 r 1, 2014
•
I hereby certify that the above informatio nd tha truction on the above described property and
the occupancy and the se will bin a ith the les and regulations of the State of Washington
e City o al Way.
Owner or agent: Date:
V
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 14 -105082 -00 -EL Address: 33702 21ST AVE SW
Project: FRED MEYER INC FEDERAL WAY, WA 98023-7762
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
EJ
UFER Ground (4295)Ditch
cover (4030)
0
Slab/Concrete Floor (4 55)
❑Right
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
EJ
Pool Bonding (4195)
Temporary Power (4275)
❑Right
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Ceiling Cover (4020)
Rough Electrical (4225)
Feeders/Sub-panels (4045)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
EJ
Rough Electrical
Approved
Final Electrical
Approved
❑Right
of Way
Approved
By
Date
By
Date
By
Date
CITY OF
ELECTRICAL
Federal Way PERMIT APPLICATION
ROCE
IvED
PERMIT NUMBER 14- _ 10 5-0,5Z
_ 00 OCT O 1
— 2014
SITE ADDRESS: 70� Z 1 S (� 1 1
/
CDS
PROJECT VALUATION
$
ASSESSOR'S TAX/PARCEL �� �
1
^ U � �
�
CURRENT/PROPOSED USE
2 Gvv
_f/�J�/
-
— — —
—
PROJECT NAME—
Homeowner
Meqtr
(Tenant or Last Name)
(Qf,�
rt
S ,
PROJECT DESCRIPTION
0
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
( _
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
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PRIMARY PHONE
MAILING ADDRESS
LCONTELECTRICAL 2i$1-� W-11 PL-
a
E-MAIL
CONTRACTOR
RACTOR
CITY
STATE
ZIP
FAX
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WA STATE CONTRACTOR'S LICENSE i
C E�— -CS %(6V\A,-)
EXPIRATION DATE
/ 3'0 //5
FEDERAL WAY BUSINESS LICENSE d
2v,0 -7 -14576? -60--&
NAME
Jc,&\e5
PRIMARYPHONE
APPLICANT
a��ct
( 2�� 0*7, _
MAILING ADD/DRESS
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CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
0.�e3 &
PRIMARY PHONE
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(�25) q 31 - 3 1661
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 thatI 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.
SIGNATURE:
PRINT NAME:
�O-1 --�q
Bulletin # 160 — January 1, 2013 Page 1 of 2 k: l-landoutsTlectrical Permit Application