15-106450 CITY OF ELECTRICAL
Federal Way PERMIT APP3feiCbN
DEC 201
PERMIT NUMBER I � _ 0
CITY OF FEDERAL WAY
CDS
q 2$ S C,o w,V V g FEdc-e�3( wiy' u/A' ' �OO 3 SUITE/UNIT/SPACE#
SITE ADDRESS: / [4---=OS OS
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
700 . od 7 c - C .' U I 0
PROJECT NAME /��( ,`�
(Tenant or Homeowner Last Name) ``V t / '
ZA)Q+4-/l c o ,14 2-yo VOff71-
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME �� PRIMARY PHONE
PROPERTY OWNER Mel 131144 ---k (2r3)617 - 9' 7 aq
MAILING ADDRESS E-MAIL
-7 206 P-D c=.
CITY STATE ZIP FAX
-20 fi)A,EY L4//- w4 9 8 3ct / ( ) -
NAME PRIMARY PHONE
SEI -AXIL GI C 12 'C_ (25-3) 572 5--5-53
MAILING ADDRESS E-MAIL
ELECTRICAL 7 0
CONTRACTOR CITY STATE ZIP FAX
l�Eti-f- o h - $b3Z ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
S C-A -H4C v772w 12 i / ) /2os)
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT O fen, Po ( )
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.
SIGNATURE: !`�! DATE ) �- —ZZ �2`>t S—
PRINT NAME 1-450Ai rje,/ -i&S
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Electrical
Permit #: 15 -106450 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: BAKER'S DOZEN
Project Address: 1928 S COMMONS Unit H-05
Project Description: INSTALL (1) CIRCUIT (50 AMP, 240 VOLT CIRCUIT)
Parcel Number: 762240 0010
Owner
ApBlican
Contractor
STEADFAST COMMONS LLC
JENI SEVERSON
SEA -TAC ELECTRIC INC
1928 S COMMONS
SEA -TAC ELECTRIC INC
SEATAEI077RW (12/17/17)
FEDERAL WAY WA 98003-6013
7056 S 220TH ST
7056 S 220TH ST
KENT WA 98023
KENT WA 98032
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. ................... 1
� IW-�
PERMIT EXPIRES S
Permit Issued on Tuesc
I hereby certify that the above information is
the occupancy and the use will be in accorc
Owner or agent:
the
of
19,
. 22,
6
5
above described property and
s of the State of Washington
Date:
CITY of
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
15 -106450 -00 -EL
STEADFAST COMMONS LLC
Address: 1928 S COMMONS Unit H-05
FEDERAL WAY, WA 98003
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.
E] Final - Electrical (4055)
Approved
By Date
UFER Ground (4295)Ditch
cover (4030)
Temporary Power (4275)13
Slab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
E] Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
0
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)
❑
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
E] Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
1:1Approved
Final Electrical
1:1Approved
Right of Way
By
Date
By
Date
By
Date