12-101861City 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: PHAN LOT 3
Project Address: 31000 20TH AVE S
Project Description: LIFER GROUND
Electr'ical
Permit #: 12 -101861 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 053700 0595
Owner
Anulicant
Contractor
LONG VAN PHAN
LONG VAN PHAN
JMH ELECTRIC LLC
THI NGUYEN LIEU
1939 LIGHTHOUSE LN NE
JWMLEL96IMN (7/15/12)
1939 LIGHTHOUSE LN NE
TACOMA WA 98422-3467
20319 80TH AVE SE
TACOMA WA 98422
SNOHOMISH WA 98296
Additional Permit Information
Is Use Educational or Institutional? ....................... No
Electrical Fixtures
New Service: Residential .............. 1 UF15�17,--6rnut4b G RU 3�r -51/1a
PERMIT EXPIRES Tuesday, October 23, 2012
Permit Issued on Tuesday, May 1, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use a in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent:
Date: c / Z r/ Z
��N,au�c 5/t/jL
'iAhl�
Federal Way
PERMIT #:
Project:
THIS CARD ISTO MAIN ON-SITE
Construction I ection Record
INSPECTION REQ TS: (253) 835-3050
12 -101861 -00 -EL Address: 31000 20TH AVE S
LONG VAN PHAN 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.
UFER Ground (4295)
Approved
By �� Date S�Z
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY Of
Federal Way ELEC'T'RICAL
PERMIT APPLICATION
ZEEIVED
MAY 0j2G12
**Most electrical permits may be obtained on-line at www. cityoffederalway. com *
SITE ADDRESS: - I1 S I j C D S
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PROJECT NAME MI\L01-
(Tenant or Homeowner Last Name)�
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAME
PRIMARY PHONE
PROPERTY OWNER
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WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE
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FEDERAL WAY SI11511n B LICENSE A
APPLICANT
NAME
PRIMARY PHONE
-
MAILING ADDRESS
19 -MALL
CUT
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
I cert(jy under penalty of pedury that I am the property owner or authorised agent of the property owner. I cart{ jy that to the best
of my knowledge, the irgformation submitted in support of this permit application is true and correct. I certVy that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's reaponsiMiity 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 costa, 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
in formation supplied to the city as apart of this application.
SIGNATURE: � /1 . DATEZ-
PRINT NAME: --
33325 a Avenue South ♦ PO Box 9718 ♦ Federal Way ♦ WA ♦ 98063-9718 ♦ 253-835-2607 ♦ fax: 253-835-2609 ♦ www.cityoffederalway.com
Bulletin #160 — April 9, 2010 Page 1 of 2 k:\Handouts\Electrical Permit Application