20-104040-EL-Electrical Application-Bulletin #160 – April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
SITE ADDRESS:
SUITE/UNIT/SPACE #
PROJECT VALUATION
$
ASSESSOR’S TAX/PARCEL #
____ ____ ____ ____ ____ ____ - ____ ____ ____ ____
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME PRIMARY PHONE
( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
ELECTRICAL
CONTRACTOR
NAME PRIMARY PHONE
( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
WA STATE CONTRACTOR’S LICENSE # EXPIRATION DATE
/ /
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME PRIMARY PHONE
( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( ) -
PROJECT CONTACT NAME PRIMARY PHONE
( ) -
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: DATE
PRINT NAME: ____________________________________________________________________________
PERMIT CENTER 33325 8th Avenue South Federal Way, WA 98003-6325
253-835-2607 FAX 253-835-2609 permitcenter@cityoffederalway.com
ELECTRICAL
PERMIT APPLICATION
PERMIT NUMBER __ __ - __ __ __ __ __ __ - __ __