19-101310Electrical
City of Federal Way - rz
Community Development Dept. Permit #•
. 9- 0 -00 -EL
33325 8th Ave S .fit
Federal Way, WA 98003 i Inspection Request Line: (253) 835-3050
Ph: (253) 835.2607 Fax: (253) 835-2609
Project Name: MONTESSORI ACADEMY
Project Address: 36605 PACIFIC HWY S Parcel Number: 292104 9074
Project Description: Replace existing wellhouse panel with new transfer panel and outlet.
Owner
Applicant
Contractor
KEJIAN FENGMONTESSORI
DOUGLAS OWENBLAZE ELECTRIC &
BLAZE ELECTRIC & SRVC CO INC
INTERNATIONAL LLC
SRVC CO INC
BLAZEES010P8 (10/28/19)
36475 PACIFIC HWY S
209 125TH ST S
FEDERAL WAY WA 98003
TACOMA WA 98444
209 125TH ST S
USA
TACOMA WA 98444
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
Alt. Srvc / Feeder 0 to 200 aml 1
PERMIT EXPIRES Thursday, 19 March, 2020
Permit Issued on Wednesday, March 20, 2019
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 oragent: Date:��
r/na�
crry a 14A
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ONSITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
1910131000 Address: 36605 PACIFIC HWY S
I EJIAN FENG FEDERAL WAY WA 98003
Scheduled inspections may be failed if this card isnot 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)
0
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
Approved
IBY
Approved
Approved to place concrete
By
Date
By
Date
By
Date
0
Pool Bonding (4195)
0
Temporary Power (4275)
0
Service (4235)
Approved
IBY
Approved
Approved
By
Date
Date
By
Date
0
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
0
Ceiling Cover (4020)
Approved
IBY
Approved
Approved
By
Date
Date
By
Date
® Final - Electrical (4055)
e
By Date "Z6 -/
0 Rough Electrical Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF A
Federal Way
RECEIVED ELECTRICAL
LIAR 2 0 2019 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER / _ / L6
SITE ADDRESS' ,
SUITE/UNIT/SPACE a
PROJECT VALUATION dPa
ASSESSOR'S TAX/PARCEL N
CURRENT/PROPOSED USE
$ j6Lrp
-
PROJECT NAME
Homeowner Last Name)
(Tenant or
PROJECT DESCRIPTION
0L
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME i�"Ir
PRIMARY PHONE
MAILING ADDRESS
6�sr�« s
E-MAIL
CITY
r 3 ATE
ZIP
FAX
--
NAME
v ,ilC
PRIMARY PHONE
of� ) Ss j -9,0 a
MAILING ADDRESS
iZ o
�-
ELECTRICAL
CITY
//STTeATE
ZIP
�,e4�
FAX
CONTRACTOR
/I
t-i�
WA STATE CONTRACTOR'S LICENSE X EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
NAME
S> C45 C�L-�
PRIMARY PHONE
szq - Op
APPLICANT
MAILIN ADDRESS
E-MAIL
CIT��
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 arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin 4160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application