16-104446city of Federal Way
community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: GERLITZ
Project Address: 28616 13TH AVE S
Project Description: Wiring for a new hot tub
Eleettrical
Permit #: 16 -104446* -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 720300 0595
Owner
ARRlicant
Contractor
JEFF M GERLITZ
HI AMP ELECTRIC
HI AMP ELECTRIC
28616 13TH AVE S
PO BOX 196
HIAMPAE942DM (3/14/18)
FEDERAL WAY WA
ROY WA 98580
PO BOX 196
ROY WA 98580
Additional Permit information
Electrical Work Valuation?....................................2100 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional? ....................... No
No Fixtures Associated With This Permit 111
PERMIT EXPIRES Friday, Septernh#
7
8rPermit Issued on Thursday, Se to�2016
I hereby certify that the above information is correct and that n ion on the above described property and
the occupancy and the use will be in accordance with he law and raoulations of the State of Washington
and the of F I Way.
Owner or agent:7 W901,
Date: ✓ �r�
A09 A
\F v
OA*
` cruor THIS CARD IS TO REMAIN ON-SITE
�/�tlM �
Federal Way Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 16 -104446 -00 -EL Address: 28616 13TH AVE S
Project: JEFF M GERLITZ FEDERAL WAY, WA 98003-3150
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
Ditch cover (Pool
BondingS13
Rough Electrical (4225)
ervice (4235)
1:1Approved
Approved
0
Approved
Approved
By
Date
By
Date
By
Date
0
Feeders/Sub-panels (4045)
0
Rough Electrical (4225)
1:1Approved
Right of Way —'
0
Final - Electrical (4055)
By
Date
Approved
Date
Approved
By
Date
By
Date
By
Date
Rough Electrical
Approved
11
Final Electrical
Approved
1:1Approved
Right of Way —'
By
Date
By
Date
By
Date
1� Federal Way
Building Division
33325 Eighth Avenue South
Federal Way, WA 98003-6325
Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: 7-14,11. 141! Ave- 5 - PERMIT#: 16 - t 0 f - c,o-tet
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IF YOU HAVE QUESTIONS CALL r%&44-
(253) 835- 1& 7-3
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.
10 1� I
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
RECEIVED
carr of
Federal Way SEP OW 2016
CITY OF FEDERAL WAY
CDS
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER
SITE ADDRESS:
rJ l� l
SUITE/UNIT/SPACE #
PROJECT VALUATION
$
ASSESSOR'S TAR/PARCEL M
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
'
PROPERTY OWNER
NAMEPRIMARY
F
� � %
PHONE
(� ,) 7,Z- 3 L7
MAILING ADDRESS �[ �l
E-MAIL
CITY
1
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
Aw,
PRIMARY PHONE
MAILIN ADDRESS/;
b CS
E -
CITYSTATE
t44
ZIP
`�7
FAX
466 ) 5s �,- 32 `j�
WA STATE CO CTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
MAILING ADDREs
PRIMARY PHONE
) E-MAIL
CITY
STATE
ZIP
( FAX
l )
PROJECT CONTACT
NAME
M l
�„� fr f� j
PRIMARY PHONE
�, �) . w 3
I cert(& 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 flied 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 t ty as a part of this application.) �(
SIGNATURE: DATE
PRINT NAME: l
Bulletin # 160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application