13-102193It I
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: FAMILY LIFE CHRISTIAN CENTER
Project Address: 1925 S 341ST PL
Project Description: Installation of exit light.
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Electrical
Permit #: 13 -102193 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 390380 0050
Owner
Applicant
Contractor
FAMILY LIFE CHRISTIAN CENTER
FAMILY LIFE CHRISTIAN CENTER
FULLER ELECTRIC (ELECTRICAL)
4004 SW 327TH ST
4004 SW 327TH ST
FULLEEI027BK (1/12/14)
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
37107 12TH AVE S SUITE A-5
FEDERAL WAY WA 98003
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
PERMIT EXPIRES Wednesday, November 13, 2013
Permit Issued on Friday, May 17, 2013
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the- use -wrill be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
5—�
Owner or agent: _ - -- Date:�—
s/t ;/Is
THIS CARD IS TOMAIN ON-SITE
CITY OF Construction In ection Record
Federal way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 13 -102193 -00 -EL Address: 1925 S 341ST PL
Project: FAMILY LIFE CHRISTIAN CENTER FEDERAL WAY, WA 98003-6006
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] LIFER Ground (4295)Ditch
cover (4030) Slab/Concrete Floor (4255)
Approved
Approved Approved to place concrete
By Date By
Date By Date
E] Pool Bonding (4195) ❑
Temporary Power (4275)Service (4235)
Approved
Approved Approved
By Date By
Date By Date
Feeders/Sub-panels (4045)
Rough Electrical (4225) E] Ceiling Cover (4020)
Approved
Approved Approved
By Date By
Date By Date
Final - Electrical (4055)
Approved
B Date
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF,
Federal Way
ELECTRICAL
PERMIT APPjZj4Fj&VON
PERMIT NUMBER / 3 _ / / j 1� / - / 5 E L
MAY 17 2013
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SITE ADDRESS: 9 2 S S
1
SUITE/U@"PACE i
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL #
.3 ! U
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
�G.,. ��rz -
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY^
STATE ZIP
` FAX
NAME —�
iy 1— r
PRIMARY PHONE
ELECTRICAL
MAILING ADDRESS C `
F -MAIL
CONTRACTOR
CITY
STATEZIP
W,
9.6.3
FAX
(_2�)
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
�U L_L_'
FEDERAL WAY BUSINESS LICENSE #
� ;
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
( FAX
PROJECT CONTACT
NAME .
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 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 a t of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tot city as a pa of this application.
SIGNATURE:
PRINT NAME:
TE`-
Bulletin #160 —January 1, 2013 Page I of 2 k:\Handouts\Electrical Pennit Application
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