17-103829 , �- . f
Electrical
City of Federal Way Permit #:17-103829-00-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: CLEMENT
Project Address: 4113 SW 315TH ST Parcel Number:873198 2830
Project Description: permit to complete work under expired permit 12-1042320-00-EL.Work is adding/altering up
to(4)circuits for new outlet/switches.
Owner Applicant Contractor
ALBERT CLEMENT ALBERT CLEMENT OWNER IS CONTRACTOR
4113 SW 315TH ST 4113SW315THST
FEDERAL WAY WA 98023-2131 FEDERAL WAY WA 98023-2131
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Additional Permit Information
Is this an Online or O.T.C.application? Yes
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Circuits-Residential 4
PERMIT EXPIRES Thursday,9 August,2018
Permit Issued on Wednesday,August 9,2017
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: Date: t I°I, 1
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THIS CARD IS TO REMAIN ON-SITE
Fecl004erai Wa Construction Inspection Record
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 17 103829 00 Address: 4113 SW 315TH ST
Project: ALBERT CLEMENT FEDERAL WAY WA 98023-2131
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) ; 2❑ Ditch cover(4030) I E Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date .By Date 1 By Date
® Pool Bonding(4195) [] Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date BY 0--, Date �p— 1 By Date
El Final-Electrical(4055)
Approved
By 7?-7;e" Date ? /? .
0 Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF
Federal Way AUG 09 2017 PERMIT APPLICATION
CITY OFEDERAL WAY 1 7 - ' 0 '3 Q �a _ �-y-1
COMMUNITY DEVELOPMENT PERMIT NUMBER Z.J _ l IJIJ
SUITE/UNIT/SPACE#
SITE ADDRESS:
PROJECTck,VAL�N_ �' ASSF�S80�TAE/PARCEL# � _ � � �� CURRENT/PROPOSED USE
9
PROJECT NAME L `
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(Tenant or Homeowner Last Name) p ` it �
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PROJECT DESCRIPTION Y C Q.O Vb c � v� t ,�
Detailed description of work to Cly) C v1/4 13C -u `�. / l
be included on this permit only
NAME 11 PRIMARY PHONE
PROPERTY OWNER ii4V\WIA• UL�1n,C ( )aal -G5G
MAILING ADDRESS E-MAIL
X13 sc° 3�5 '—` "6k-
CITY STATE ZIP FAX
NAME PRIMARY PHONE
OUbbe- - (S C-s \roG \c ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
Ci-e C .- 103)?a'"? - SG)
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
c C (1)(-1.(1 1- LAI ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT ( 1
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: . ' DATE U 1 n
PRINT NAME: V l C iE'VN CA.N.A -
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application