19-100857 1111, •
Electrical
City of Federal Way Permit #:19-100857-00=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: PEDIATRICS NORTHWEST
Project Address: 505 S 336TH ST Parcel Number:926480 0270
Project Description: Relocate(7)existing T-stats.Add(1)T-stat.
Owner Applicant Contractor
RH FOUNTAIN PLAZA ASSOC LLC DYLAN EMDEPERFORMANCE PERFORMANCE HEATING&A/C(EL 06)
PO BOX 5003 MECHANICAL GROUP PERFOHA005BS(2/01/20)
BELLEVUE WA 98009 1012 CENTRAL AVE S
KENT WA 98032 1012 CENTRAL AVE S
KENT WA 98032
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
Thermostat 8
PERMIT EXPIRES Saturday,22 February, ,2020
Permit Issued on Friday,February 22,2019 •
I hereby certify that the above information is correct and that the construction on the above described property
and the occ cy and he use will be in accordance with the laws, rules and regulations of the State of
hington and the City of Federal Way. .-27 /
Owner or agent: Date: 2�/`
'net i
r
THIS CARD IS TO REMAIN ON-SITE �,.� ,
Construction Inspection Record r
ewderaly INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 100857 00 Address: 505 S 336TH ST
Project: RH FOUNTAIN PLAZA ASSOC LLC FEDERAL WAY WA 98003-6328
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 UFER Ground(4295) Q Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) El Temporary Power(4275) ® Service(4235)
Approved Approved Approved
•
By Date By Date By Date
CI Feeders/Sab-paaeb(4045) ® Rough Electrical(4225) ID Ceiling Cover(4020)
Approved Approved Approved
By Date f
By Date Date z..-
By �--l�
o Final-Electrical(4055)
Approved
By eDate� 6 /9
*
0 Rough Electrical ❑ Final Electrical Q Right of Way
Approved Approved Approved
By Date By Date .By Date
CITYO ELECTRICAL
F
Federal WayREGENED PERMIT APPLICATION
E?. 2 2 2019 PERMIT NUMBER J - 1 V 0 s) 57 _
co N�pEVE OpMENZwisx ' — — — —
M SUITE/UNIT/SPACE►
SITE ADDRESS: 50 5 5 3 6-- S'T
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 16Uo* a o Z G 4- g" U 0 2 7 U
PROJECT NAME �'
(Tenant or Homeowner Last Name)
I OUA-6:h P1412.0l Pei".1-,-;(--5- AjW T-I
(Z2loc-,-,4-- L> eX/Sli`'r 1--514fS . Adj (t) He.,,/ T-s-ft
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER /WDr-►( In/c-7 L"VW-is-c ( ) -
MAILING ADDRESS E-MAIL
16655 NE 4-ft. 5+ +7°6
CITY STATE ZIP FAX
be Ile,/,/e. \-,7A G1 3-0 OF ( ) -
_._ .. NAME PRIMARY PHONE
perC0e-41/4/7c M 4cb 1e I &0n (253 ) 3W0 _-v6 " 9
MAILING ADDRESS E-MAIL
dd __ lM b✓OIL. G-OM
ELECTRICAL 1012_ LC�►f-It /� s Y�a'►-� � 9
CONTRACTOR CITY STATE ZIP FAX
� 946",1 �e.4 uA e?gJ3L ( ) _
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
eta. f011p 1A Oos 6 S Z / I 55-0
NAME �'' PRIMARY PHONE
Jlj n r 1 (2.55) 3 _ OOP,
APPLICANT - MAILING ADDRESS E-MAIL
WIZ- Le^T/q / /LC- S dylc;1. eQ pm54,4I4_. C CM
CITY STATEZIP FAX
Cna w�} '18032- ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT ( ) _
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 investigati d defense of such claim), which may be made by any person,including the undersigned,and filed against the city,
but only w e h claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
informatio s ppl d to the city as part of this application. 272-2/
� /
SIGNAT - DATE `72.2 / /1
PRINT NAME: /JY/A`l l% 4.0 L
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application