15-104112 rts __
• • Electeal
4. City of Community&Ecoon.raDev.Services Permit #: 15-104112-00-EL
33325 8th Ave S
Federal way,WA 98003 Inspection Request Line:
PR'(253)835-2607 Fax (253)835-2609 p q (253)835-3050
Project Name: O'SULLIVAN
Project Address: 3023 SW 339TH ST Parcel Number: 873216 0110
Project Description: (1)circuit for microwave
Owner Applicant Contractor
DEREK J OSULLIVAN DEBBY KROLL. OLD TIME ELECTRIC INC
TINA A OSULLIVAN OLD TIME ELECTRIC INC OLDTIEI021LB(6/2/16)
3023 SW 339TH ST 5602 81ST ST E PO BOX 39745
FEDERAL WAY WA 98023 PUYALLUP WA 98371 LAKEWOOD WA 98498
Additional Permit Information
Is this an Online or O.T.C.application? Yes Is Use Educational or Institutional? No
Electrical Fixtures
Circuits-Residential 1
PERMIT EXPIRES Wednesday, February 10, 2016
Permit Issued on Friday,August 14, 2015
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the will be in accordance with the laws, rules and regulations of the State of Washington
and the Ci
of Federal Way.
Owner or agent C16.1 � v�-�X Date: '7 - lY - 45—
ED
FN
AL
THIS CARD IS TO REON-SITE j
CITY of '1MN��!� � ns •
Construction Ip'V ion Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 15-104112-00-EL Address: 3023 SW 339TH ST
Project: DEREK J OSULLIVAN FEDERAL WAY, WA 98023-7771
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.
O UFER Ground(4295) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
❑ Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
o Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
O Final-Electrical(4055)
Approved
By $i,3 Date r I n f i s
El Rough ElectricalID Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
1P RECEIVED III
AUG 14 2015 ELECTRICAL
CITY OF
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER \ 5 _ 1 0 14 1 1 ` _ E L-'
SITE ADDRESS: 30 a3 Sl) 3 39 ST M+UrrE/UNrr/Merwcs.
PROJECT VALUATION ASSESSO 'S TAX/PARCEL• CURRENT/PROPOSED USE
$ 61 a5,Oo s A 3 z 1 0 c 1 0
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION 0 Ci r c.-0'f A k'r° Vsc___
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER b.`-re--V, 05 V\1 v o•v-\ (d53) a a ct (
MAILING ADDRESS E-MAIL
30 a3 S1.J 339*'- S
ZIP r�
STATE
� qg o a3 ( ) FAX
NAME PRIMARY PHONE
oa 7-1 _ItcA-Y:c.._ 1 v`c_ 053 ) INT - 3 19-5—
MAILING/ADDRESS,/, F.-MAIL
O `
ELECTRICAL JCC 3 -14 5
4 d e bb L\@ 014 '}! e(ecc-k.
CONTRACTORc>TY STATE
ZIP
FAX Cow.—
C1 t 4 (e3 3) t( 3 t f
i ! WA STATE CONTRACTOR'S LICENSE i EXPIRATION DATE FEDERAL WAY EUSIIIESS LICENSE i
j 1 L2 2.- 01-p-rZ ET 03-1_L$ /
NAME PRIMARY PHONE
APPLICANT
MAILING ADDRESS ( ) E-MAIL
2 D D C1 U CITY STATE ZIP FAX
9 ( ) -
NAME PRIMARY PRONE
PROJECT CONTACT ave--
( ash 19PG-7-) 3gg5
I certify under penalty of perjury that I am the property owner or authorised 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 as a part of this application.
r
I I I
SIGNATURE: kA4-( 4°\,
DATE OID- /5PRINT NAME: �\�_s_ •1 S l
Bulletin#160-January 1,2013 Page 1 of 2 k:HIandouts\Electrical Pertnit Application