19-104721 1111, 4
Electrical
City of Federal Way Permit #:19-104721-00-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: RETREAT AT MAPLE HILL- BUILDING 2
Project Address: 1904 SW 321ST LN Parcel Number: 132103 9101
Project Description: Replace lights,switches and receptacles in Units 17 and 21.
Owner Applicant Contractor
RETREAT AT MAPLE HILL RETREAT AT MAPLE HILL OWNER IS CONTRACTOR
1901 SW 320TH ST 1901 SW 320TH ST
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
.',15,1,t0'21144, . - .: :..,.,,.... �, ....., 3 f ., .
Circuits
-Multi-family 4
PERMIT EXPIRES Wednesday,30 September,2020
Permit Issued on Tuesday,October 1,2019
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and the us be in accordance with the laws, rules and regulations of the State of
/ Washington ate,;.= Ci 1 • •-rat Way.
Owner or agent ,,, Date: Ad /�
THIS CARD IS TO REMAIN ON-SITE
CITY OFConstruction Inspection Record
Way ay INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 104721 00 Address: 1904 SW 321ST LN Bldg 02
Project: RETREAT AT MAPLE HILL FEDERAL WAY WA 98023
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 UFER Ground(4295) ' Q Ditch cover(4030) ® Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
•By Date By Date By Date
•. ,
0 Pool Bonding(4195) El Temporary Power(4275) •1 Q Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) ! ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
o Final-Electrical(4055)
,A oved
By ,r�i t DatejO9a//
El Rough Electrical 0 Final Electrical Right of Way
• Approved Approved Approved
By Date By Date By Date
RECEIVED
CITY OF ELECTRICAL
OCT 01 2019
Federal WayG7YOFFEDERAL WAY PERMIT APPLICATION
cOMMUNfY DEVELOPMErf
PERMIT NUMBER /9 _ / 5, _
SUITE/UNIT/SPACE#
SITE ADDRESS:
I 0 Sco ) 32I 2.4 � a7 e)a �
PROJECT VALUATION 6^7 O e A SESSOR'S TAX/PARCEL# CURRENT/PR OSED USE
•
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Re-ky(a,,, .. - ) 111 .101 e f-/ /1/ (is3)838 -6677
MAILING ADDRESS E-MAIL
1
4101 Sees 3Z dttn )lbetier,lir �be enl,to�n
CITY STATE ZIP F
1'cderg L. 0)NsiWA- 98°
NAME r PRIMARY PHONE
CSL) ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS ( ) E-MAIL
CITY STATE ZIP FAX
( )
NAME ( PRIMARY PHONE
PROJECT CONTACT 1 I r\ (253 )6 - iE 7-7
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 ci a part of this application.
SIGNATURE: //.- DATE /6 - / -/ r
PRINT NAME: -f//c',O fP 2.6.2 - rJ
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application