14-103464C �
Electrical
City of Federal Way
Community & Econ. Dev. Services Permit #: 14 -103464 -00 -EL
33325 8th Ave S
Federal Way, WA 98003 '
Ph: (253) 835-2607 Fax: (253) 835-2609 Inspection Request Line: (253) 835-3050
Project Name: KNUDTSON
Project Address: 31510 41ST AVE SW Parcel Number: 873198 2470
Project Description: 0-200 amp service changeout
Owner
JANE KNUDTSON
ARRlicant
R & R ELECTRIC SERVICES INC
Contractor
R & R ELECTRIC SERVICES INC
PO BOX 23204
11809 116TH ST E
RRELERE963CF (2/8/16)
FEDERAL WAY WA
PUYALLUP WA 98371
11809 116TH ST E
98093
PUYALLUP WA 98371
PERMIT EXPIRES I
Permit Issued on
I hereby certify that the above information is correct a
the occupancy and the u accordan the
ity of
Owner or agent:
f
w
�v
1012015
li!llrtion on the above described property and
and regulations of the State of Washington
Date: / c
CITY OF ♦�&
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
14 -103464 -00 -EL Address: 31510 41 ST AVE SW
JANE KNUDTSON FEDERAL WAY, WA 98023-2116
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.
UFER Ground (4295)Ditch
cover (4030)
Temporary Power (4275)
lab/Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
0
Temporary Power (4275)
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date _7
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
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF 'A
Federal Way
PERMIT NUMBER 14
?7 4
ELECTRICAL
JUL 14 2014
rmr nG CCmCDAI IAIAW
SITE ADDRESS:
SUITE UNI
PROJECT VALUATION
AS�SOR'S TAR/PARCEL # � � _ � O
—�-2/1—1 _ _ __
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
4( d1_50 A-1
PROJECT DESCRIPTION
2 /
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
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GQ
PRIMARY PHONE
( ) -
MAILING ADDRESS
'2_86�)
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EMAIL
CITY
STATE
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ZIP
/ 3
FAX
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NAME
2
PRIMARY PHONE
g s-24/00
PAMING ADDRESS %
% O �� sf
EMAIL
ELECTRICAL
CONTRACTOR
CITYST
TE
ZP937
FAX
`
A ATE C CTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
/ Z//
APPLICANT
NAME
j
`
PRIMARY PHONE
(Z S3) 25,5 - _// S 7S
MAILING/ANDD S '
EMAIL
CITY
�
ZIP
FAX
PROJECT CONTACT
N
�
PRIMARY PHONE
(ZS3) zs_ - %S75
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 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 apart of this application.
SIGNATURE: DATE _711,Y1,
PRINT NAME:
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application