19-103499 w.
Electrical
City of Federal way Permit #:19-103499-00-EL
Convnunity 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: ST FRANCIS OPERATING ROOM&CORE RENOVATION
Project Address: 34515 9TH AVE S Parcel Number: 750451 0020
Project Description: Installation of data cabling for operating rooms.
Owner Applicant Contractor
JOHN ELSWICKFRANCISCAN HEALTH LARRY INTRACOMMUNICATION NTWK SYS IN
SYSTEM-W HOWSERINTRACOMMUNICATION NTWK (INSI)(06)
1717 S"J"ST SYS IN(INSI) INTRANS994JL(4/10/21)
TACOMA WA 98405 4922 N PEARL ST 4922 N PEARL ST
TACOMA WA 98407 TACOMA WA 98407
Additional Permit Information
Is this an Online or O.T.C.application? Yes
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Low Voltage-Other(Commel 1
PERMIT EXPIRES Tuesday,21 July,2020
Permit Issued on Monday,July 22,2019
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
Wash' .ton and the City of Federal Way.
Owner or -_ _ - _ Date: 7, a 2 —1
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THIS CARD IS TO REMAIN ON-SITE
CITY Of Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 19 103499 00 Address: 34515 9TH AVE S
Project: JOHN ELSWICK FEDERAL WAY WA 98003-6761
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) 0 Ditch cover(4030) 3❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
BY Date ABy Date 104By Date •
® Pool Bonding(4195) El Temporary Power(4275) i ® Service(4235)
Approved Approved Approved
By Date By Date By Date
•
El Feeders/Sub-panels(4045) i ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved Approved�4
By Date By Date By .7 C' Date „ y
El Final-Electrical(4055)
Approved �j
By G�� ' ` Date ''4# <4V
CI Rough Electrical El Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
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� RECEIVED ELECTRICAL
carr of
Federal Way JUL 2 2 2019 PERMIT APPLICATION
CITY OF FEDERAL WAY // q
COMMUNITY DEl/ELO� NUMBER � g _ / ®3 `7"" / - E
SITE ADDRESS: �� , De$ SUITE/UNIT/SPACE#
ys`/f y �� s - e,/ 1 it'y 4x, ,,,,,-s
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ /7 DW. 7SO y � / - ' oo o
PROJECT NAME
(Tenant or Homeowner Last Name) S-7 , .Le /,L.. / Adr_ ...10��Zoz-v d...4 ......_ v
. ,�-/ia1L .mow A,7,,, exa‘5 14'7 ,.* -Or7 P/f r G e x-
PROJECT DESCRIPTION 7Ze '/ 4se- /Zoa'...s
Detailed description of work to ///� /r2‘,v5-ce
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER i, e,,f6',4ra //7e:�/7/2 (z.5-• 1552 - y/ Y 9
MAILING ADDRESS E-MAIL
/ 7/ 7_ S_ S S'co-i-/V+hse-, mtegfbo 1.11 �0
CITY STATE ZIP FAX ( '"/
72LGLLr-,1, /il- W Ve'I ( ) -
NAME PRIMARY PHONE
. ./{/S I (253 ) 76 7- V/1'
MAILING ADDRESS / E-MAIL
ELECTRICAL 'Y.2Z ,vo',7` ,e/f„ ( ' ' 242X7 ,41/143,c4 ,' .cokei
CONTRACTOR CITY STATE ZIP FAX
7/2 / /1 /14-. fY.7 (2,3 ) '7- D/16
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
.7i(/7)2/A/t/f 9V,72- % //' /-i2( a.2e-0/-/ 06.t-3-47G-.iZ
NAME /744-ex. PRIMARY PHONE
APPLICANT 'G,g/e�y v5 3 )70 - o Y/f
MAILING ADDRESS E-MAIL
/e 2Z ,(/ . /4°//2/ 5--//, Llai/ t 471/`>s' A'7.,--,�-.
CITY STATE ZIP FAX
7c"` Lr/r? ')6 K° 7 (257 s 7f'- D/f'e-
NAME PRIMARY PHONE
PROJECT CONTACT L Aeie y / .e. 53 ) 73L 3 VS--
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 oft application.
SIGNATG7
k.f DATE 7- Z - 2 D/
PRINT NAME: Z,/'r /444 7/2
Bulletin#160-April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application