14-105014r
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609 FILE
Project Name: KLEREKOPER
Project Address: 32503 41ST AVE SW
Project Description: Change out electrical panel.
Electrical
Permit #: 14 -105014 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 873196 0910
Owner
Anolicant
Contractor
TIMOTHY KLEREKOPER
BLACK HILLS INC (ELECTRICAL)
BLACK HILLS INC (ELECTRICAL)
JANICE KLEREKOPER
1003 85TH AVE SE UNIT A
BLACKIB919DL (3115115)
32503 41ST AVE SW
OLYMPIA WA 98501-5706
1003 85TH AVE SE UNIT A
FEDERAL WAY WA 98023-2607
OLYMPIA WA 98501-5706
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes Is Use Educational or Institutional? ....................... No
Electrical Futures
Alt. Serv./Feeder: 0 to 200 amps (F 1
PERMIT EXPIRES Saturday, March 28, 2015
Permit Issued on Monday, September 29, 2014
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
d the City of Federal Way.
1 i/�
Owner or agent: 1141 Date: 9-dg'lY
1
CITY OF
Federal Way
PERMIT #:
14 -105014 -00 -EL
THIS CARD IS TO MAIN ON-SITE
Construction In ection Record
INSPECTION REQ TS: (253) 835-3050
Address: 32503 41 ST AVE SW
Project: TIMOTHY KLEREKOPER FEDERAL WAY, WA 98023-2607.
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)13
lab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
M
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
El
Final - Electrical (4055)
Approved
By
VW, Date (n
J1-2-
RoughElectrical
Approved
M
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
411
CITY OF -.
Federal Way
SEP 2 9 2014
CITY OF FEDERAL WAy
CDS
PERMIT NUMBER _ 10 E
! /_
•
ELEC'T'RICAL
PERMIT APPLICATION
SITE ADDRESS:
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S T�ARCEL # � _ � � � �
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeoumer Last Name)
S ^�
r
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER-
NAME
PRIMARY PHONE
MAILINQ ADDRESS
E-MAIL
CITY6TATE
ZIP
FAX
(M3) - G575 -
ELECTRICAL
CONTRACTORCITY
NAME
(4 ,
�5 1(�
PRIMARY PHONE
(-,&)705 - o
MAILING ADDRESS G�
E-MAIL
s�AT�„
('(
�
FAX
WA�STATECCONT C O
LICE E # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENS #
APPLICANT
NAME
PRIMARY P
( ) 0!�- `
MAILING ADDRESS
(0c) FD ffl�i
E-MAIL
CITY
STATE
ZIP0(,U1A).aL(,k
( ) W -
PROJECT CONTACT
NAME,�� _M
PRIMARY PHONE
( ) 7C*D
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 suc im arises out of the reliance the city, including its officers and employees, upon the accuracy of the
information suppl' d t e cit,�s1atparAt of AhA app li ion
SIGNATURE:
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Bulletin #160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application