11-103302 mi. Electfilal .
City of Federal Way • i
Community Development Services Permit #: 11-103302-00-E L
4 P 0 Box 9718
Federal Way,WA 98063-9718835-
Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 P 4
Project Name: GOMEZ 2%4"
Project Address: 30522 5TH AVE SW Parcel Number: 178890 0370
Project Description: Adding/altering 0-200 amp service
Owner Applicant Contractor
CAROLINE K GOMEZ HI AMP ELECTRICAL HI AMP ELECTRICAL
30522 5TH AVE SW P 0 BOX 196 HIAMPAE942DM(3/14/12)
FEDERAL WAY WA 98023 ROY WA 98580 P 0 BOX 196
ROY WA 98580
e sti•:. 'n =.1r '?;. dltlonal 'Pe Eal ?, .i � raf4y'.
Is Use Educational or Institutional? No
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Alt. Serv./Feeder: 0 to 200 amps(F 1
' PERMIT EXPIRES Wednesday,'August 15, 2012
Permit Issued on Tuesday, August 16, 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
the ty of Federal Way.
Owner or agent. (47/(ii)and
Date. f -/ t` m 1/
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• THIS CARD IS T MAIN ON-SITE
•
CITY OF 40;
Construction In ection Record
Federal Way INSPECTION REQU TS: (253) 835-3050
PERMIT#: 11-103302-00-EL Address: 30522 5TH AVE SW
Project: CAROLINE K GOMEZ FEDERAL WAY, WA 98023-3914
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
•
Q Pool Bonding(4195) .El Temporary Power(4275) _____D Service(4235)
Approved - Approved Approved Approved - -
'By Date By Date By C-‘t•C-r7)
Date -6`1 I
0 Feeders/Sub-panels(4045) El Rough Electrical(4225) CI Ceiling Cover`(4020)
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055)
Approved
By 0 t>,..0 Date O' _1 l
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
,-,141111%., • • jO3O2
CITY OF ." - —
Federal Way ELECTRICAL RECEIVED
PERMIT APPLICATION AUG 16 Nal
**Most electrical permits may be obtained on-line at www.ci 'RAL WAY
!)'''JY -1/SITE ADDRESSj: .) tP\ U•( . l �� „ ��/ P, �.
SUITE/UNIT/SPACE r 1ASSEss3 TAX/PARCEL* � 0 - O . � 0 /CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name) Y,/-f r Jl ( -)6 fl'1 F2r1_'
PROJECT DESCRIPTION ifi)f ' JP'Yj I(' 7��rl i),,
Detailed description of work to
c_-)0/) I
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAIL NG ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
ELECTRICAL
NAME 6 ' PRIMARY PHONE r E-MAIL
4”;
_f___
MAILING E ��)af, o (,1 yYl(( �„jr'I e `l ),1r�'y' F ti t i(.
tAillCONTRACTOR C STATE ZIP -+ FAS„WA STATl..)\:Jo
9ONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
/• ZYfy,p4Fe,q& in 2//2_ //
NAME PRIMARY PHONE
APPLICANT ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT
if i/ .3)>r,,�1Z-- ( ) -
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.
-- /I '1 2 2 '
SIGNATURE: 1— /1 --- ' .. DATE CJS ./J' _/l
r
PRINT NAME: I /r)J ,i.4 / /7'b i //4 /)r✓ J
33325 8'"Avenue South•Federal Way•WA♦98003-6325•253-835-2607•fax:253-835-2609♦www cityoffederalway.com
Bulletin#160-January 1,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application