16-101793.., A
w _ _ n, !
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: BROSSEL
Project Address: 1254 SW 301ST ST
Project Description: Replace (2) 200 amp panels
0
Electrical
Permit #: 16 -101793 -00 -EL
Inspection Request Line: (253) 8353050
Parcel Number: 515320 0285
Owne
Aonlicant
Contractor
KENNETH L BROSSEL
RUBEN CARDONA
D & A ELECTRIC LLC
THORESON BROSSEL
D & A ELECTRIC LLC
DELECE897D5 (4/5/17)
1254 SW 301ST ST
11909 VICKERY AVE E
11909 VICKERY AVE E
FEDERAL WAY WA
TACOMA WA 98446
TACOMA WA 98446
98023
Additional Permit Information
Electrical Work Valuation?....................................4000 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No
Electrical Fixtures
Alt. Serv./Feeder: 0 to 200 arnps (F 2
PERMIT EXPIRES Wednesday, April 12, 2017
Permit Issued on Tuesday, April 12, 2016
1 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
and the City of Federal Way.
Owner or agent Date:
CITY OF to
Federal Way
PERMIT NUMBER 1
ApR 12 2016
CITY DF FLDERAL WAY
CDS
E&CTRICAL
PERMIT APPLICATION
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 Iaws.
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:
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\l-landouts\Electrical Permit Application
SUITE/UNIT/SPACE #
SITE ADDRESS:
PROJECT VALUATION
$
A
ASSESSOR'S TAR/PARCEL #�T
,� 5 3 Z
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAVer?
PRIMARY PHONE
PROPERTY OWNER
1
V53 jZ2 _5,:5J L
MAILING ADDRESS
E-MAIL
L
CITY
rSTATE .
ZIP /
FAX
NAME
PRIMARY PHONE
(2S )
MAILING ADDRESS
E-MAIL
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE #
Jf C -�
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
)
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
/ FAX
l )
PROJECT CONTACT
NAME
L�I, 1,
PRIMARY PHONE
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 Iaws.
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:
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\l-landouts\Electrical Permit Application
-_
CITY OF '0U&
Federal Way
PERMIT #:
Project:
THIS CARD IS TOMAIN ON-SITE
Construction In ection Record
INSPECTION REQ TS: (253) 835-3050
16 -101793 -00 -EL Address: 1254 SW 301ST ST
KENNETH L BROSSEL FEDERAL WAY, WA 98023-3413
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.
❑
LIFER Ground (42 5)El
Ditch cover (4030)
Final Electrical
Approved
Slab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
❑
Pool Bonding (4195)
Temporary Power (4275)
Final Electrical
Approved
1:1Approved
Service (4235)
By
Approved
Approved
Date
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
Final - Electrical (4055)
Approved
❑
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date