16-101510Project Name: RETINA SPECIALISTS NW
Project Address: 33915. IST WAY S Unit 204
Project Description: install low voltage CCTV system
ectlical
Permit #: 16 -101510 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 926504 0150
Owner
A Rlo icant
City lit Federal Way
RETINA SPECIALISTS NORTHWEST, PLLC
Community 8 Econ. vev. Services
A D T LLC (ELECTRICAL 06)
33325 8th Ave S
FILE
Federal Way, WA 98003
FEDERAL WAY WA 98003
Ph: (253) 836-2607 Fax: (253) 835-2609
11824 NORTH CREEK PKWY SUITE 105
Project Name: RETINA SPECIALISTS NW
Project Address: 33915. IST WAY S Unit 204
Project Description: install low voltage CCTV system
ectlical
Permit #: 16 -101510 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 926504 0150
Owner
A Rlo icant
Contractor
RETINA SPECIALISTS NORTHWEST, PLLC
JENNIFER COVELLO
A D T LLC (ELECTRICAL 06)
33915 1ST WAY S SUITE 120
ADT LLC -
ADTLLL*881D0 (3/20/18)
FEDERAL WAY WA 98003
11824 NORTH CREEK PKWY SUITE 105
11824 NORTH CREEK PKWY SUITE 105
BOTHELL WA 98011
BOTHELL WA 98011
Additional Permit Information
Electrical Work Valuation?....................................1156 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional? ....................... No Service greater than 999 Amps? ............................. No
Electrical Fixtures
Low Voltage - Other (Commercial 1
PERMIT EXPIRES Tues
1*ch 28, 2017
Permit Issued on Monday arch 28, 2016
I hereby certify that the above information is correct and that the construction the above described property and
h th
the occupancy and the use will be in accordance with s, rul s an tions of the State of Washington
�tstl t Federal
Owner or agent
CV
Date:
crry OF
Federal Way
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
16 -101510 -00 -EL Address: 33915 1ST WAYS Unit 204
RETINA SPECIALISTS NORTHWE: 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.
Final - Electrical (4055)
Approved
By Date
UFER Ground (4295)
Ditch cover (4030)
Temporary Power (4275)Service
Slab/Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
Temporary Power (4275)Service
(4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Rough Electrical (4225)
E]
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date