16-101737 • - Electrical
City of Federal Way 16-101737-00-EL
Community&Econ.Dev.Services Permit tf��jj:
33325 8th Ave S
Federal Way,WA 98003 ism Insim ection Re uest Line: 253 835-3050
Ph:(253)835-2807 Fax:(253)835-2809 P q
Project Name: MIRROR LAKE VILLAGE SENIOR HOUSING BLDG B
Project Address: 836 SW 312111 ST Parcel Number: 072104 9087
Project Description: New 3,000-amp electrical service and wiring for new assisted living facility.
Owner Applicant Contractor
MIRROR LAKE VILLAGE LLC BRUCE DUNN MERIDIAN CENTER ELECTRIC INC
PO BOX 6961 15049 NE BEL-RED RD MERIDCE318SG(2/28/17)
BELLEVUE WA 98008 BELLEVUE WA 98007 11109 66TH AVE E
PUYALLUP WA 98373
Additional Permit Information
Electrical Work Valuation 450000.00 Is this an Online or O.T.C.application? No
Is Use Educational or Institutional'? No Service greater than 999 Amps? No
Electrical Fixtures
New Service:over 1000 amps(Cot 1
PERMIT EXPIRES Wednesday, May 10, 2017
Permit Issued on Tuesday, May 10, 2016
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: ittk Date: .5110/ I
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-101737-00-EL Address: 836 SW 312TH ST
Project: MIRROR LAKE VILLAGE LLC FEDERAL WAY, WA 98023-4515
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) El Ditch cover(4030) - 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
•By Date By , Date ,a,/, ,../ •By Date s,4,.-1...1
0 Pool Bonding(4195) '❑ Temporary Power(4275) illi. Service(4235)
Approved Approved Approved
By Date By Date By j2/ Date
0 Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By . Date By ,e, Date 2-3/, 1/ By ' 0" — Date /,---/g•-;227'
El Fir....._nal-Electrical(4055)
Approved
By Date /n 3 %
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Approved Approved Approved
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RECEIVED •
ELECTRICAL
CITY OF 111111
APR 0 7 2016
Federal Way PERMIT APPLICATION
CITY OF FEDERAL WAY � �� r r w
PERMIT NUMBER ( - ` 0 (
o a I tU
SUITE/UNIT/SPACE#
SITE ADDRESS: gz`1'��
PROJECT VALUATION ASSESSOR'S TAX/PARCEL iE CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name) I* Q(Z LA-10i_ \I I
PROJECT DESCRIPTION bt, O v r a-- vl Y`p u h 61- 6eke ,
Detailed description of work to
be included on this permit only " i‘
NAME d PRIMARY PHONE
PROPERTY OWNER V-` e�012- LAV-e_ ��1 LL
MAIL G ADDRESS E-MAIL
130)c. (C=•CI( CIb I -a-+4-tC C A .c)0411
CITY STATE ZIP FAX
NAME PRIMARY PHONE
r1*(210 14�l G$a-te. l 61.12V--(11\6. ) (262')04S- 6G a 5-
MAILING ADDRESS E-MAIL �(�
ELECTRICAL 11 1 Q O( Ce .V(o � I� Ave S@_,r4 Le,' TrZe_.,.i'O net
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Mi ERA
NAMEi PRIMARY PHONE
APPLICANT C4A-Nt 1 JO2Dom-4-� `<k)Ce. 1 11\,L (4z-Cit-4-7D-3173
MAILING ADDRESS. E-MAIL
IS 4t� t� Z l-ee E-MAIL
C044,1
CITY STATE ZIP FAX
$2\L v u� 1AI IS+0-7 ( 25)4,43- 4b 0
NAME PRIMARY PHONE
PROJECT CONTACT - tJ _ Do (4z5) 89D- 2_9 0 cell
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 •art of this application.
SIGNATURE: ` DATE \ ✓
PRINT NAME: V Lse - -i/l7
Bulletin#160—January 1,2013 Page 1 of 2 k:\flandouts\Electrical Permit Application