16-101950Electi lcal
Cl�, of Federal v. S
Community &Econ. Dev. Services � Permit #: 16 -101950 -00 -EL
33325 8th Ave S
Federal Way, WA 96003 Inspection. Request Line: 253 835-3050
Ph: (253) 835-2607 Fax: (253) 835-2609 p q
Project Name: KLEMM ER
Project Address: 3900 SW 321ST ST Parcel Number: 873190 2510
Project Description: Add (5) circuits in kitchen and bathrooms.
Ownr
Ap IIR cant
Contractor
DENNIS W KLEMMER
DANIEL RAY JACKSON
'TAHOMA ELECTRIC INC
TERRI L KLEMMER
TAHOMA ELECTRIC INC
TAHOMEI151BJ (10/3/17)
3900 SW 321ST ST
PO BOX 45397
PO BOX 42267
FEDERAL WAY WA 98023-2412
TACOMA WA 98445
TACOMA WA 98442
Additional Permit Information
Electrical Work Valuation?...................................2400 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No
Electrical Fixtures
Circuits - Residential ...................... 5
1 hereby certify that
the occupancy and
Owner or agent:
PERMIT EXPIRES Saturday, ri
Permit Issued on Frida P4 16
inf ma ' is correct and thatt ction of
in cordance with the laws, s an r
and the City of F I Way.
U.
W
'
17
bove described property and
ions of the State of Washington
Date: y ZZ f(�
THIS CARD IS TO REMAIN ON-SITE
Federal Way Construction Inspection Record
FINSPECTION REQUE TS: (253) 835-3050
PERMIT #: 16 -101950 -00 -EL Address: 3900 SW 321ST ST
Project: DENNIS W KLEMMER FEDERAL WAY, WA 98023-2412
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.
0
UFER Ground (4295)1:1
Ditch cover (4030)
1:1Approved
Slab/Concrete Floor (4255)
1:1Approved
Approved
Service (4235)
Approved
Approved
to place concrete
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Approved
By Date
Final - Electrical (4055)
Approved
By Date
Rough Electric
Approved
5;�_ Date 7_
Ceiling Cover (4020)
Approved
By Date
El
Pool Bonding (4195)
❑
Final Electrical
Approved
0
1:1Approved
Temporary Power (4275)
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Approved
By Date
Final - Electrical (4055)
Approved
By Date
Rough Electric
Approved
5;�_ Date 7_
Ceiling Cover (4020)
Approved
By Date
El
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
DATE
`I. Z1
O.
AREA AND TYPE OF INSPECTION
40
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CITY OF
Federal Way
Receww ELEC'T'RICAL
APR 2 2 2016 PERMIT APPLICATION
CITY OF FEDERPPIE 0 NUMBER
CDS-- ------ --
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SITE ADDRESS: 3 a � � C i _ } -3� 15 1 ��
SUITE/UNIT/SPACE k
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL f
CURRENT/PROPOSED USE
PROJECT NAME
Homeowner Last Name)
�C2vv�
(Tenant or
rn� r r
-e-4,`LaCT
PROJECT DESCRIPTION
Detailed description of work to
S S
t
be included on this permit only
PROPERTY OWNERa
NAME
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PRIMARY PHONE
(2 J 3 )G O � - I � � Ll
MAILING ADDRESS
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E-MAIL
CITY
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STATE
fZIIP -�
FAX
NAME
PRIMARY PHONE
MAILING ADDRESS
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E-MAIL
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ELECTRICAL
CITY
STAT531�_FAX
CONTRACTOR
STATEWA CONTRACTOR'S�/LICENSE�r
FEDERAL WAY BUSINESS LICENSE N
U
/ � / � � �
NAME
PRIMARY PHONE
APPLICANT
( )
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
i
jj
PRIMARY PHONE
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I certify under penalty of perfury 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 91pim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information suppiie he ciAas apart of tiffs applidation.
SIG ATAM:
PRINT NAME:
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Bulletin # 160 —April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application