19-104566 Electrical
City of Federal Way Permit #:19-104566-00-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: BROOKDALE SENIOR LIVING
Project Address: 32290 1ST AVE S Parcel Number: 172104 9039
Project Description: New circuit and wiring replaced make-up air unit; new T-stat.
•
Owner Applicant Contractor
BROOKDALE SENIOR LIVING BRETT ROEBUCKAir Systems Engineering AIR SYSTEMS ENGINEERING INC
6737 W WASHINGTON ST SUITE 2300 3602 S PINE ST (ELECTRICAL)
MILWAUKEE WI 53214 TACOMA WA 98409 AIRSYEI009KS(5/10/20)
3602 S PINE ST.
TACOMA WA 98409
Additional Permit Information
Is this an Online or O.T.C.application" Yes
Circuits-Commercial 1 Thermostat 1
PERMIT EXPIRES Tuesday,22 September,2020
Permit Issued on Monday,September 23,2019
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
Washin ton and the City of Federal Way. d
Owner ca gg ent: � A ]e� Date: 2 i Zi f I
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THIS CARD IS TO REMAIN ON-SITE ... -'
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Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 104566 00 Address: 32290 1ST AVE S
Project: BROOKDALE SENIOR LIVING FEDERAL WAY WA 98003
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.
UFER Ground(4295) ® Ditch cover(4030) ® Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date •, By Date
•
•
0 Pool Bonding(4195) ® Temporary Power(4275) ® Service(4235)
Approved Approved I Approved
I
By Date By Date By Date
Q Feeders/Sub-panels(4045) , ® Rough Electrical(4225) 1 ® Ceiling Cover(4020)
Approved Approved Approved
By Date , By Date By Date
o Final-Electrical(4055)
�/ Approved
By ,f jQ Date A /7/
El Rough Electrical El Final ElectricalElRight of Way
Approved Approved Approved
By Date By Date By Date
ELECTRICAL
CITY OF RECEIVED
Federal Way PERMIT APPLICATION
SEP 2 3 2019
CITY OF FEDERAL WAY PERMIT NUMBER ( _ I �,/�
J 1-1 SI, _
COMMUNITY DEVELOPMENT — — — —
� ' SUITE/UNIT/SPACE M
c
SITE ADDRESS: 3 2 2 10 15T 1 �2
PROJECT VALUATION ASSESSOR'S TAX/PARCEL I CURRENT/PROPOSED USE
$ (0 ( , 00 11I�� 1 2 1 0 4 - 9 0 3 9
PROJECT NAME
enant or r Last Name) V K0 J 1APA FOUND/17(0N -1-\61,)5E 7 i\T C J PA\i f)
PROJECT DESCRIPTION N E� �f U,� W 1 R i N Cr if 1Z
Detailed description of work to RP (g) AR Pa__ U N`7
be included on this permit only
1\10W x- 87
NAME PRIMARY PHONE
PROPERTY OWNER P?'( C)OVA171)1. 5 .1'k C LI V ifs& ('183 ) 25 9 - 4`b20
MAILING ADDRESS E-MAIL
(07 37 W Nein ii\N(37 N ST s-re 2300 TOS7KEfl gRooRM ,CITY
IMItUA liC� \J\ ZIP 53214- ( ) FAX
NAME PRIMARY PHONE
PAR -)1 1N Fi+lh1NU'R \1'i6. INC. (2572 ) 512 - `14Yzl
MAILING ADDRESS E-MAIL
ELECTRICAL 3602. 5o ? )NE 5T 'ire iR e ASCI ,.t.)
CONTRACTOR CITY STATE ZIP FAX
-TACOVAI Wet `) 8449 ( 283) 3 - (b7737
WA STATE CONTRACTOR'S LICENSE a EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE I
l�1�5'(E1 O09V,5 5 \D /Z0 I9--13 -000O( -O -8L
NAME PRIMARY PHONE
APPLICANT a R F '� 133 U C� ( ) -
MAILING ADDRESS E-MAIL
SCC c,ori-rKACTOR
CITY STATE ZIP FAX
( )
NE
PROJECT CONTACT NAME (��� `` (�4 Erg U C K ( ) PRIMARY
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 authorised 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 aapart�of th application.
i J
SIGNATURE: �ai f2`'0'ivCA S El/1l'PRINT NAME: DATE 9 3�f e btcK
� � �0
PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application