16-105790 Electrical
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City of Federal Way � �:" '---;.--0 Permit #:16-105790-00-EL
Community Development Dept. . :
33325 8th Ave Sr .„:„-- 1
Federal Way,WA 98003 ' Inspection Request Line (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 j _1 , +,,,
Project Name: VILLAGE GREEN HEARTHSIDE AND GARDENS
Project Address: 35419 1ST AVE S Parcel N , r: 302104 9024
Project Description: Relocate light,switches and outlets.Relocate smoke and heat det tors.
Owner Applicant 1 I ontractor '
VILLAGE GREEN FEDERAL WAY DAN HENRYWESTERN PACIFIC , .1v ' ' PACIFIC SURVEILLANCE
PO BOX 98309 SURVEILLANCE SOL INC SOL INC
DES MOINES WA 98198 15330 159TH LN SE STEPS916KM(5/30/17)
YELM WA 98597 15330 159TH LN SE
YELM WA 98597
Additional Permit form. '''
Is this an Online or O.T.C.application? Yes
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PERMIT EXPIRES . it:day, D c if ber,2017
Permit Issued onJ►�Ve• ,e , , c ber 7,2016
I hereby certify that the above information �- -ct and • e construction on the above described property
and the occupa y and the use will •- 1: •rdance 1 the laws, rules and regulations of the State of
W- ' g and the City of Federal Way.
Owner or agent: 11/1') ,7 Date: / 2 — 7-il
' NutTHIS CARD IS TO REMAIN ON-SITE
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Federal Construction Inspection Record
INSPECTION REQ TS:(253)835-3050
PERMIT#: 16 105790 00 Address: 35419 1ST AVE S
Project: VILLAGE GREEN FEDERAL WAY 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) 0 Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date I.By Date
® Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
,
0 Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By ._ Date. Z—ZIP--\L By O , Date 1 2..3.„„1
10 Final-Electrical(4055)
Approved
By Date
0 Rough Electrical El Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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NI" CITY OF Building Division
33325 Eighth Avenue South
v. .,., Fed a ra I WayFederal Way,WA 98003-6325
Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
ADDRESS' 3 y. i Q 1 4-,,,,- PERMIT#: 1, LQ - 1 C, s ri q ---- L
catix:Nizqt_ S., 0 Jr.- t.- J 119,A-V+ : k‘ \ - ' El r"2 cA, �.
4t C C 'SS \ a-%••;41..._,,
IF YOU HAVE QUESTIONS CALL (253) 835- A. (. 1,:l
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
CITY OF 41k RECEIVED
Federal Way DEC V 2016
ELEC'T'RICAL
PERMIT APPLICATION
CITY OF FEDERAI ERAMIT NUMBER / (10 _ a 5
CDS
SITE ADDRESS: 5 L j / `S ✓ e
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SUITE/UNIT/SPACE#
PROJECT VALUATION
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ASSESSOR'S TAX/PARCEL #
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CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
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Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILINGADDRESSS I
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E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
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ELECTRICAL-�
CONTRACTOR
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FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
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FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
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MAILING ADDRE
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E-MAIL
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FAX
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PROJECT CONTACT2ZPjr&!5
NAME
PRIMARY PHONE
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1 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 1 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 Iocal, 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:
PRINT NAME:
Bulletin # 160 — April 14, 2016
Page 1 of 1
k:\Handouts\Electrical Permit Application