19-105126 . r.
Electrical
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City of Federal way Permit #:19-105126-00-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: MADRONA PARK ASSISTED LIVING AND MEMORY CARE
Project Address: 31200 23RD AVE S Parcel Number:092104 9127
Project Description: Relocating(3)outlets for 2nd floor laundry room remodel.
Owner Applicant Contractor
HSRE-PMB MADRONA LLC CHRIS MAYEDAC M E ELECTRIC LLC C M E ELECTRIC LLC
3394 CARMEL MOUNTAIN RD SUITE 200 30262 225TH AVE SE CMEELEL865QE(11/5/20)
SAN DIEGO CA 92121 BLACK DIAMOND WA 98010
30262 225TH AVE SE
BLACK DIAMOND WA 98010
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Circuits-Commercial 3
PERMIT EXPIRES Friday,23 October,2020
Permit Issued on Thursday,October 24,2019
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 a e City of Federal Way.
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Owner or agent: Date:/4 2y
17/ A/4F i///
THIS CARD IS TO REMAIN ON-SITE
"�°` Construction InspectionsRecord
redera.Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 105126 00 Address: 31200 23RD AVE S
Project: HSRE-PMB MADRONA LLC 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 lett 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.
® LIFER Ground(4295) ® Ditch cover(4030) 3❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
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® Pool Bonding(4195) s❑ Temporary Power(4275) ® Service(4235)
Approved Approved I Approved
By DateBy Date By Date
,
0 Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved I Approved
By Date By if, Date / `-'45:70•900 1 By Date
El Final-Electrical(4055)
Approved
By e Date,^3 —a
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•
0 Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date , By Date By Date
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RECEIVED ELECTRICAL
CITY of A.
Federal Way OCT 2 4 2019 PERMIT APPLICATION
CITY RAL WAY
COMMUNITY DEVELOPMENT /
PERMIT NUMBER / 9 _ / 051 _
, SUITE/UNIT/SPACE#
SITE ADDRESS: 3 l /2"0� 2 /' ��-S
oc -00
PROJECT VALUATION ASSESSOR'S TAR/PARCEL# CURRENT/PROPOSED USE
$ 'oo- 0 r' .X 0 L? - `9 1 a 52,h‘, vi Ass i c+
PROJECT NAME ,
(Tenant or Homeowner Last Name)
Lau...-il r (e3.," (Le-fr - .L...\ 2 r--106K--- J
PROJECT DESCRIPTION Vin-e14/1-0 C Imo_
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
C v't& E (:r Lei..-f-j s L ( ) -
MAIL ADDRES E-MAIL
ELECTRICAL V•`-- • � IJ^
7 6
CONTRACTOR CITY S T ZIP FAX
7-DD �►� q iO l O ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ctitice6 L e L�C4 (--aE ' i i _
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS • ( ) E-MAIL
CITY STATE ZIP FAX
( )
N PRIMARY PHONE
PROJECT CONTACT b. /„p(1 )2c.ve...\ (3(9$ ) 77 --Z 0C--
I
"'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: Py� vC te 43/DATE / 2 till
PRINT NAME. r / $ `' Ar't / �G
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application