12-101246 vCommunCty of Federal
Services Permit#: 12-101246-00-E L
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:.(253)835-2609 p q
Project Name: EDMONDS
Project Address: 30100 11TH PL S Parcel Number: 515390 0040
Project Description: Emergency replacement of electrical panel.
Owner Applicant Contractor
DWIGHT&JOSIE EDMONDSON DWIGHT&JOSIE EDMONDSON DELTA WYE ELECTRICAL LLC
30100 11TH PL S 30100 11TH PLS DELTAWE936B3(1/23/13)
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003 17002 PACIFIC AVE S
SPANAWAY WA 98387
•
Additional Permit Information
Is Use Educational or Institutional? No
Electrical Fixtures
Alt.Serv./Feeder:0 to 200 amps(F 1
PERMIT EXPIRES Saturday, September 15, 2012
Permit Issued on Monday, March 19, 2012
I hereby certify that the ab• e informatio• i orrect and that the construction on the above described property and
the occupancy and th- • : will ,- in -/•dance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: /' Date:
3���
FIN."l ! D 3ft /ia.
THIS CARD IS TO MAIN ON-SITE
f.
Federal '* • Construction I ection Record A
Way INSPECTION REQ TS: (253)835-3050
PERMIT#: 12-101246-00-EL Address: 30100 11TH PL S
Project: DWIGHT & JOSIE EDMONDSON FEDERAL WAY, WA 98003-4147
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.
O UFER Ground (4295) ❑ Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) ElTemporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
❑ Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
O Final-Electrical(4055)
Approved
B .,......„.7
Date-– l —/ 2
E Rough ElectricalEl Final Electrical `El Right of Way
Approved Approved Approved
By Date By Date By Date
04.
CITY OF .,,•
Fe 1%1 a ELECTRICAL
RMIT APPLICATION
0* ; electrical permits may be obtained on-line at www.cityo ederalway.com**
SITE ADDRESS: �� l C Sr✓.
SUITE/UNIT/SPACE# ASS SOR'S TAX/PARCEL#-5� - CURRENT/PROPOSED USE3q0 00 (40
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PRIMARY PHONE
PROPERTY OWNER ( )20Z - 2/7/
MAILING ADD- -- E-MAIL
G' `. Jad/CITY 4
W ) FAX
NAME PRIMARY PHONE
) -
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 CSCOi, ,,� ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP ( FAX
)
NAME PRIMARY PHONE
PROJECT CONTACT ( ) -
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 t reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to 'ty • a p this application.
„.
SIGNATURE: , DATE
PRINT NAME:
33325 8i°Avenue South•Federal Way•WA•98003-6325•253-835-2607•fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160—January 1,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application