11-101718 " 1
•City oederal Way • Elec ricJ
Community Development Services Permit #: 11-101718-00-EL
PO.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (2
53)835-3050
Project Name: HALVERSON FILE
Project Address: 31519 53RD AVE SW Parcel Number: 321020 0358
Project Description: Altering up to 4 circuits for a septic system repair.
Owner Applicant Contractor
CASEY R HALVERSON NORTHWEST CASCADE INC NORTHWEST CASCADE INC
31519 53RD AVE SW PO BOX 73399 NORTHCI148BG (10/1/11)
FEDERAL WAY WA 98023-2012 PUYALLUP WA 98373 PO BOX 73399
PUYALLUP WA 98373
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Is Use Educational or Institutional? No
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Circuits-Residential 4
PERMIT EXPIRES Friday, May 4, 2012
Permit Issued on Thursday, May 5, 2011
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 Washington
and the City of Federal Way.
Owner or agent:W__)---04 (( Date: S'S It
5/11/0
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Lection Record"
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT #: 11-101718-00-EL Address: 31519 53RD AVE SW
Project: CASEY R HALVERSON FEDERAL WAY, WA 98023-2012
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(4030) 0 Slab/Concrete Floor(4255) 0 Pool Bonding(4195)
Approved Approved to place concrete Approved
By Date By Date By Date
❑ Service(4235) 0 Feeders/Sub-panels(4045) ❑ Rough Electrical(4225)
Approved Approved Approved
By Date By Date By Date
0 Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved
By Date By asiot
Date S_,h_i I '
0 Rough ElectricalEl Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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CITY of ..' ,,,_.,..„....,,„1,64,r)
WtEe ELECTRICAL
MAY o h '-'\ PERMIT APPLICATION
E ��rwAY
„ ` �t^F t electrical permits may be obtained on-line at www.cityo federalwa��.conl**
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SITE ADDRESS: 3 1 1 5, s3 ,r d) Ave' $tA;
SUITE/UNIT/SPACE# ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME �///
(Tenant or Homeowner Last Name) Ma-102#P.5 0:I �aS-¢-i/
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAME PRIMARY PHONE
PROPERTY OWNER (a y 1"t c / /S c,,A (10 b ) 5 O/- O 443
MAILING ADDRESS E-MAIL
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CITY STATE ZIP FAX
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NAME PRIMARY PHONE
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MAILING ADDRESS E-MAIL
ELECTRICAL ?-0• Sox 7'33 9g �ar7C N�/cTasc.<�tfuv�n
CONTRACTOR CITY STATE ZIP FAX
fklya.fllke (Ail'''. 28373 (Z53 ) 816- 2399
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME PRIMARY PHONE
APPLICANT ( )
MAILING ADDRESE-MAIL
CITY (0)AA C STATE ZIP FAX
( )
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 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 suppliedtto the city as a part of this application.
SIGNATURE: I2(- ' ����`''t DATE C-6--- //
PRINT NAME: gob4fi 9 /• 6:00/11.4.1C1 AdixlN/1/7.4--7447/
33325 8th Avenue South•Federal Way♦WA•98003-6325♦253-835-2607•fax 253-835-2609•www.cityoffederalway.com
Bulletin#160—January I,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application