12-100817City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
• ' Electrical
Permit #: 12 -10081'7 -06 -EL
..,„ Inspection Request Line: (253) 835-3050
Project Name: MIDDLETON
Project Address: 718 SW 294TH ST
Project Description: Altering up to 4 circuits for bathroom remodel
Parcel Number: 119600 0340
Owner
Al2RIicant
Contractor
ROBERT T MIDDLETON
SUSAN T MIDDLETON
SUSAN T MIDDLETON
SUSAN T MIDDLETON
718 SW 294TH ST
718 SW 294TH ST
718 SW 294TH ST
FEDERAL WAY WA 98023-3542
FEDERAL WAY WA 98023-3542
FEDERAL WAY WA 98023-3542
Additional Permit Information
« Is Use Educational or Institutional? ....................... No
Electrical Fixtures
Circuits - Residential ...................... 4
PERMIT EXPIRES Sunday, August 19, 2012
Permit Issued on Tuesday, February 21, 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 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: ;z-
Va THIS CARD IS TO REMAIN ON-SITE
FeConstruction I ection Record
Federal Way INSPECTION REQ TS: (253) 835-3050
PERMIT #: 12 -100817 -00 -EL Address: 718 SW 294TH ST
Project: ROBERT T MIDDLETON FEDERAL WAY, WA 98023-3542
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.
Rough Electrical (4225)1:1 Ceiling Cover (4020) Final - Electrical (4055)
Approved Approved Approved
B Date By Date By\// ? Date C 2 7 J i
Rough Electrical
Approved
n
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
F aY ELEC'TRICAL
r, P�
WMIT APPLICATION
f
C coest electrical
permits may be obtained on-line at www. cityo
ederalway.com**
SITE ADDRESS:
SUITE/UNIT/SPACE #
ASSESSOR'S TAX/PARCEL li
CURRENT//P�R,OP`0SED USE
L�
0 �w 'w U C7Wi
PROJECT NAME
(Tenant or Homeowner Last Name)
Y I TU
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NOISE
NAME
`J usa"v` T
PRIMARY PHONE
MAILING ADDRESS
E_L
7 5t,
suelle�c� ww �.
CITY
3TATE
ZIP
FAX
NAME
PRIMARY PHONE
U wv`ex
MAILING ADDRESS
E.NAIL
ELECTRICAL
CONTRACTOR
CITY
STATE
ZIP
FAX
( ) -
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
NAME
D w
PRIMARY PHONE
( )
APPLICANT
MAILING ADDRESS
EMAIL
CITY
STATE
ZIP
/ FAX
1 ) -
PROJECT CONTACT
NAME
130 Vl\, AA le,,LV, 5�2 AA � ✓
PRIMARY PHONE
(2 53) g Z.'133
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. 1 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 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:1 �� '�C ��� DATE L Z
PRINT NAME:
33325 8h Avenue South ♦ Federal Way ♦ WA ♦ 98003-6325 ♦ 253-835-2607 ♦ fax: 253-835-2609 ♦ www.cityoffederalway.com
Bulletin #160 — January 1, 2011 Page 1 of 2 k:\Handouts\Electrical Permit Application