19-102173 Electrical
City of Federal Way Permit #:19-102173-00-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: JACKSONS#636-GAS CANOPY
Project Address: 1520 S 348TH ST Parcel Number: 889700 0115
Project Description: Wire(6)fuel dispensers,(2)tanks and a fuel canopy.
Owner Applicant Contractor
JACK DAVISPACWEST ENERGY LLC MIKE JACKSONTRI-M ELECTRIC LLC TRT-M ELECTRIC LLC.
3450 COMMERCIAL PKWY CT 21827 93RD PL W TRIMEL*981PS(10/10/20)
MERIDIAN ID 83642 EDMONDS WA 98020
3509 NE 187TH CT
LAKE FOREST PARK WA 98155
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
� � ' e> a s { V
PERMIT EXPIRES Tuesday,5 May,2020
Permit Issued on Monday,May 6,2019
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
iashington - -d the 'ty of Federal Way.
Owner or agent: � Date: )4/Zie)
THIS CARD IS TO REMAIN ON-SITE . ' . -
. ,101At. . .
CITY Inspection Record
Federal Vinay INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 102173 00 Address: 1520 S 348TH ST
Project: JACK DAVIS -FEDERAL WAY WA 98003-6844
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.
1❑ UFER Ground(4295) ® Ditch cover(4030) 3❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date ! By Date By Date
,
® Pool Bonding(4195) ® Temporary Power(4275) Q Service(4235)
Approved Approved Approved
By Date By Date By Date
•
1:1 Feeders/Sub-panels(4045) ® Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date j By Date
•
9 Final-Electrical(4055)
Approved
By Date // '/,/�/
0 Rough Electrical 0 Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date
........_„"k RECEIVED ELECTRICAL
CITY OF
Federal Way MAY 0 5 2019 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT n _
PERMIT NUMBER a ) _ 1 O ( '/ 3 _ Cc/
SUITE/UNIT/SPACE#
SITE ADDRESS: /6-40 6 iT6 Y4 / otivo /rUL
PRSED USE
$O//OJ DOJECT TIOON ASSESSOR'S TAX/PARCE # CURRENT/PleOV o _ D / 1 /��C/POC (/fir
PROJECT NAME ..---- of
(Tenant or Homeowner Last Name) / k o f 6 1
,� (b) 7v 1. 4)& A15 s /O.. SKS
PROJECT DESCRIPTION 410 A Uzi 0410t/
Detailed description of work to
be included on this permit only
NAME..., i•--• PRIMARY PHONE
PROPERTY OWNER C G�r ee_ �/ i (tab)?3a - 03oz,
MAILING ADDRESS / E-MAIL
3,Ko Gent t ,fie' L. ? iyG�"
CITY STATE ZIP FAX
e1AI 836"-i.z. ( ) -
NAME ....."'"• PRIMARY PHONE
/ fr d �v-G ig (i/z4i773- `fb77
MAILING ADDRESS �•l /•�:e/�- �`•C
ELECTRICAL %So/ �� f�
� '7 C'r .f/'O/rticr-,,�GDy/1
CONTRACTOR CITY v (J ST TE ZIP FAX
1447e6 FOZ6Cr ae< MYI 6g‘c ('/25)778- 1910
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
``-r� z_.4-9g/p5 <0 /10 / Zo 20-11-M0/4•77..Dp.X33[..
N`AMMEE PRIMARY PHONE
(
APPLICANT k/—' E Gr,O/ ('/ZSR)773- '77
MAILING ADDRESS . t� r• MAI
✓v,reia tin
CITY STATE ZIP FAX
l C � 9 '14 i e V
(sig i7?e-lvq()
NAMEPRIMARY PHONE
PROJECT CONTACT &/J� - /�`-.-------,K0p1) (4* 773 4Z77
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 appli ation.
SIGNATURE: '�� ,�i�AO DATE y / f✓V
111
PRINT NAME: - .11. •
Bulletin#160-April 14,2016 Page 1 of 1 k:U-Iandouts\Electrical Permit Application