19-102307 1 J
Electrical
City of Federal Way Permit #:19-102307-00-EL
Community Development Dept.
33325 Sth Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: KLONTZ
Project Address: 36907 17TH AVE S Parcel Number:721266 0590
Project Description: Electrical work to include re-attaching service feeder conduit to the building and add inter
bonding connector.
Owner Applicant Contractor
SHARON KLONTZ SERGEY MULYARCHUKIMPACT IMPACT ELECTRIC LLC
36907 17TH AVE S ELECTRIC LLC. IMPACEL882Q8(11/28/20)
FEDERAL WAY WA 313 14TH AVE
98003-7597 MILTON WA 98354 PO BOX 1600
MILTON WA 98354
Additional Permit Information
Is this an Online or O.T.C.application? Yes
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PERMIT EXPIRES Saturday,9 May,2020
Permit Issued on Friday,May 10,2019
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
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Washington and the City of Federal Way. I'''.
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Owner or agent: Ser ut'Drc `�4�C Date: '.(0-11
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THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 102307 00 Address: 36907 17TH AVE S
Project: SHARON L KLONTZ FEDERAL WAY WA 98003-7597
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.
El UFER Ground(4295) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) Temporary Power(4275) I ® Service(4235)
Approved i Approved Approved
Date 5-l�=fl
By •�By Date 1 By Date
El Feeders/Sub-panels(4045) ® Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
•
1:1 Final-Electrical(4055) •
By 1Z Approved
Date if/ "l
l
0 Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF . RECEIVED ELECTRICAL
Federal Way PERMIT APPLICATION
MAY 102019
CITY OF FEDERAL WAY
GOMMUNI-tY DEVELOPN' MIT NUMBERI _ 1 6 Z ' 0 7 _
SUITE/UNIT/SPACE#
£ C�-
SITE ADDRESS: 56 q 0
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ q50 2 ! v & _ D 5 5 0
PROJECT NAME
(Tenant or Homeowner Last Name) 1
pe. - L +4e,c k Se r✓lce, -reed.r coin c i/ 4-0
PROJECT DESCRIPTION bu t id,i/1 6he, er.��/ ,i1-4 - iz1rie/e cstioce,-6r-
Detailed description of work to r/
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER S in 0(0i1 C. G('ee r' (aob Y330 -66L7
MAILING O 1 DRESS /�/ E-MAIL
3 CITY 1 / I *N AS Jcle STATE ZIP c,b 4 c,Io F ( Q, o tAti,
FAX
(-- t( lit/eL� 414 9 t 00 l ( ) - _
NAME U PRIMARY PHONE
-Lira c-4- e e c..4 ri'c LLC ( ) -
MAILING ADDRESS E-MAIL //
ELECTRICAL n (fix /600 ���c<e/&A i c.ne f�q�.r,/•c�,
CONTRACTOR CITY, STATE ZIP FAX Vv
PI/ I-Oit) WA 3S 35' 1 ( )
2 a/ 33 WA STATE
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CO (a'S LICENSE#2 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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—NAME (T) C^�)'l/._X,) - - PRIMARY PHONE
APPLICANT -r 111 u I �(c LLt k ( ) -
MAILI G S E-MAIL
3Y01 S 53r00 ctik, _.
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a3v p 53 CITY
auk rKSTATE ZIP FAX
WA 1C \ ( ) -
NAMEPRIMARY PHONE
PROJECT CONTACT Srt,e �u ariiuk (a 06 ) 76S-6S65?V
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 a part of this application.
SIGNATURE: _....--i- DATE - —/0
5,009—
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PRINT NAME: 3 C rs e' m u f o rcAl u)c
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application