19-103956 Electrical
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City of Federal Way Permit #:19-103956-00-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: STARBUCKS
Project Address: 33650 21ST AVE SW Parcel Number:930100 0020
Project Description: Fire alarm system,adding(14)devices.
Owner Applicant Contractor
MATT FERGUSONCONFLUENT DESIREE FORQUIGNONGUARDIAN GUARDIAN SECURITY SYSTEMS
DEVELOPMENT LLC SECURITY SYSTEMS (ELECTRICAL)
2240 BLAKE ST SUITE 200 1743 1ST AVE S GUARDSS233K5(9/30/20)
DENVER CO 80205 SEATTLE WA 98134 1743 1ST AVE S
SEATTLE WA 98134
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Low Voltage-Fire Alarm(Co 14
PERMIT EXPIRES Friday, 14 August,2020
Permit Issued on Thursday,August 15,2019
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
Washington and the City of Federal Way.
COQOwner or agent: Date: (1 Stt G
THIS CARD IS TO REMAIN ON-SITE
alOF 4O -• Construction Inspection Record -
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 103956 00 Address: 33650 21ST AVE SW
Project: MATT FERGUSON FEDERAL WAY WA 98023-7762
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.
® Slab/Concrete Floor(4255) Q Rough Electrical(4225) 0 Final-Electrical(4055)
Approved to place concrete Approved Approved p
�By Date ��By Date By�� f/ Date /ot3"�'
0 Rough Electrical 0 Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED
AUG 15 2019 ELECTRICAL
CITY of CITY OF FEDERAL WAY
Federal Way coMMUNITYDEyELOPMENT PERMIT APPLICATION
PERMIT NUMBER 0 ,
SUITE/UNIT/SPACE#
SITE ADDRESS: --) sb RA6t ../k,,e : v\i
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
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PROJECT NAME
(Tenant or Homeowner Last Name) A v\ou cs k 1
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER vac)Y\ C\() oc oA (u(\)C YU k (,200q19;-�'2?.
MAILING ADDRESS C
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MAILING ADDRESS E-MAIL
((((���� ELECTRICAL" V1‘VJ l Y t',
CONTRACTOR ITT I STATE` �ZyIP r/ FAX
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WA STATE CONTRACTOR'S LICENSE S EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE S
NAME PRIMARY PHONE
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NAME a� PRIMARY PHONE
PROJECT CONTACT h��� `'ct'W('i j\.v- IA-0 Y\ (W)(Q 1 O
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. \ l UDloil� DATE G l "`�I t
PRINT NAME: Ill."s ii 10( )�
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Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application