16-10364141k
CITY OF
Federal Way
RECEIVE®
JUL 27 2016
CITY OF FEDERAL WAY
CDS /
PERMIT NUMBER 1 Cp _ v 3 �( 1
ELEC'T'RICAL
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 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:
PRINTNAME: R04$r PAlf
TE 7Za4 /14
4
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter�ti;;cityoffederalway.com
Bulletin # 160 -April 14, 2016 Page 1 of 1 k:\-landouts\Electrical Permit Application
SUITE/UNIT/SPACE #
SITE ADDRESS:
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL #
CURRENT/PROPOSED USE
59,478.00
8 9 4 7 2 0- 0 1 2 0
New Housing
PROJECT NAME
(Tenant or Homeowner Last Name)
Eagle Manor
Installation of a City of Federal Way owned street
lighting system in a new development being built
PROJECT DESCRIPTION
under the name of Eagle Manor, to include seven new
Detailed description of work to
be included on this permit only
light poles and one new service cabinet.
NAME
PRIMARY PHONE
PROPERTY OWNER
696 LLC
( -
MAILING ADDRESS
E-MAIL
CITY
STATE
I ZIP
/ FAX
l
NAME
PRIMARY PHONE
Totem Electric of Tacoma Inc
(253) 383- 5022
MAILING ADDRESS
E-MAIL
ELECTRICAL
2332 Jefferson Ave
Rogerp@Totemelectric.com
CITY
STATEZIP
FAX
CONTRACTOR
Tacoma
WA
98402
(253 )272 - 5214
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
TOTEMET315BS 9/ 30 /17
19 -99 -106730 -00 -BL
NAME
PRIMARY PHONE
Totem Electric of Tacoma Inc
(253) 383- 5022
APPLICANT
MAULING ADDRESS
E-MAIL
2332 Jefferson Ave
Rogerp@Totemelectric.com
CITY
STATE
ZIP
FAX
Tacoma
WA
98402
(253 )272 - 5214
PROJECT CONTACT
NAME
Roger Palfenier
PRIMARY PHONE
( 253 ) 722 - 2838
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 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:
PRINTNAME: R04$r PAlf
TE 7Za4 /14
4
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter�ti;;cityoffederalway.com
Bulletin # 160 -April 14, 2016 Page 1 of 1 k:\-landouts\Electrical Permit Application