19-102075 Electrical
City yDevalFederal Way Permit #:19-102075-00-EL
Community Development Dept
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: BROOKLAKE SENIOR LIVING
Project Address: 32290 1ST AVE S Parcel Number: 172104 9039
Project Description: Extend existing 120V circuit for future water feature.
Owner Applicant Contractor
BROOKDALE SENIOR LIVING JIM MOOREUNITY ELECTRIC UNITY ELECTRIC LP
6737 W WASHINGTON ST SUITE 2300 20306 15TH AVE NE UNITYEL919L9 (7/13/21)
MILWAUKEE WI 53214 SHORELINE WA 98155
20636 15TH AVE NE SUITE A
SHORELINE WA 98155
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Circuits-Commercial 1
PERMIT EXPIRES Thursday,30 April,2020
Permit Issued on Wednesday,May 1,2019
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy nd the use will be in accordance with the laws, rules and regulations of the State of
7,,Washington and the City of Federal Way.
Owner or agent: Date: /% 9
F I 14
1
44A, THIS CARD IS TO REMAIN ON-SITE
�� Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 102075 00 Address: 32290 1ST AVE S
Project: BROOKDALE SENIOR LIVING 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.
i] UFER Ground(4295) El Ditch cover(4030) ID Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date /By / 4 Date + / By Date
® Pool Bonding(4195) El Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
'
7❑ Feeders/Sub-panels(4045) ® Rough Electrical(4225) *L-3 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
Approved
By "/�..iDate ,r--- 9-/.
0 Rough Electrical 0 Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
REGEIV ELECTRICAL
CITY OF ED
Federal Way MAY 01 2019 PERMIT APPLICATION
COMMUNITY CITY OF FEDERAL W, ' I D O7 s� _ Ci
EVELOp AAT NUMBER — -
SUITE/UNIT/SPACE/
SITE ADDRESS: l Z Z 6, D / :r �u� �'
o
PROJECT
VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ e " I -/ 2 f D u - Cj 0 3 7
PROJECT NAME
(Tenant or Homeowner Last Name) T;20C2g--0,1i*r DUvoi//a,) v—cc
P-xTE''1/i) .-'X!S7-//u r_ / c' C//Zc✓.PT d'o/L I�ur u.2
PROJECT DESCRIPTION "frtf r*PAPTv<L
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER X, 6a 0,.- ) 2,3 a= i52-?
MAILING ADDRESS E-MAIL
3 Z7i9d l rf9ve Svs-cov�c-o.cs it: '_ T,21e
CITY STATE ZIP FAX , C per-,
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N - PRIMARY PHONE
OPT Li
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MAILING ADD ETj��„, c, is-7-'dvc NZ: E-MAIL
ELECTRICAL u/ •
CONTRACTOR CITY STATE ZIP FAX
,.5#0,c1 c ivv6 w I `)?/S. ( ) -
WA STATE CONTRACTOR'S LICENSE# ^ EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
( )
NAM PRIMARY PHONE
PROJECT CONTACT /AL Jt4OS (2°6 ) g/o 3?o y
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 city as a part of this application. / c�
SIGNAT DATE ( r /
PRINT N i//M /WE10,4,t/
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application