19-105058 r r
Electrical
City of
Community De eloral Dept. FILE Permit #:19-105058-00-EL
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: JACOBSON, BRETT H DDS
Project Address: 1718 S 288TH ST Parcel Number: 332204 9109
Project Description: Electrical to include installation of new LED lighting,Installation of 2 outlets and move existing
connections in two casework locations.
Owner Applicant Contractor
JACOBSON LLC B KEVIN RAUR-C TRUE LINE CORP R-C TRUE LINE CORP
1718 S 288TH ST 15321 105TH AVENUE CT E RCTRULC038QG(11/7/21)
FEDERAL WAY WA PUYALLUP WA 98374 15321 105TH AVENUE CT E
98003 PUYALLUP WA 98374
• Additional Permit Information
Is this an Online or O.T.C.application9 Yes
4;4..f�� _. 3ra� .. �..'�.. � '
PERMIT EXPIRES Tuesday,20 October,2020
Permit Issued on Monday,October 21,2019
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.
Owner or agent Date: 127-/—/ 9
4 - w
THIS CARD IS TO REMAIN ON-SITE
AIN'OA' ON-SITE
CInspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 105058 00 Address: 1718 S 288TH ST
Project: JACOBSON LLC B FEDERAL WAY WA 98003-3260
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.
I •t •♦
® UFER Ground(4295) ® Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date (By Date By Date
El Pool Bonding(4195) ® Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date I By Date
•
•® Feeders/Sub-panels(4045) ® Rough Electrical(4225) I ® Ceiling Cover(4020)
Approved Approved Approved
By Date ; By Date ' By Date
El Final-Electrical(4055)
Approved
By /L, Date/A-- .,-/7
0 Rough Electrical El Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
WY OF RECEIVED
OCT 21 20r
ELECTRICAL
Federal Way PERMIT APPLICATION
CITY OF AY
COMMUNITY DEVELORALPMENT
PERMIT NUMBER 11 _ / 5 5 o s g _ E L
SUITE/UNIT/SPACE#
SITE ADDRESS: 1718 S 288th S t
PROJECT VALUATION ASSESSOR'S TAC/PARCEL# CURRENT/PROPOSED USE
$ 14 , 175 332204 9109 _ _ _ _ _ Dental Office
PROJECT NAME Dr .. Bret Jacobson
(Tenant or Homeowner Last Name)
Installation of new LED lighting
PROJECT DESCRIPTION installation of 2 outlets
Detailed description of work to Move existing connections in two casework
be included on this permit only
locations
NAME PRIMARY PHONE
PROPERTY OWNER Dr . Bret Jacobson ( 254839-4111
MAILING ADDRESS c o o r d ismat o r
1718 S 288th ST jacobsondds . coi
CITY STATE ZIP FAX
Federal Way WA 98003 ( ) -
NAME PRIMARY PHONE
R-C True Line Corp . ( 25846-l562
MAILING ADDRESS E-MAIL
ELECTRICAL 18 415 78th Ave E
CONTRACTOR CITY STATE ZIP FAX
Puyallup WA 98375 ( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
. RCTRULC038QG 11' 7 / 1920- 12 -10138600-BL
NAME PRIMARY PHONE
Kevin Rau (25) 846-1562
APPLICANT MAILING ADDRESS
E-MAIL
18415 78th Ave E
CITY STATE ZIP FAX
Puyallup WA 98375 ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT Nick Rau (2 5) 377- 7504
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 10—Z I - tell
PRINT NAME: key,I IZ/a-A
PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
253-835-2607+ FAX 253-835-2609 +permitcenter@eityoffederalway.com
cityoffederalway.com
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application