20-100721City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: BAERENWALD
Project Address: 4129 SW 328TH ST
Project Description: Rewire basement - altering about 4 - 6 circuits.
Electrical
Permit #:20-100721-00-EL
Inspection Request Line: (253) 835-3050
Parcel Number: 873203 0280
Owner
Applicant
Contractor
RYAN BAERENWALD
NIKOLAY GORBUNSUPREME ELECTRIC
SUPREME ELECTRIC
4129 SW 328TH ST
LLC.
SUPREEL94606 (9/26/20)
FEDERAL WAY WA 98023-2628
PO BOX 786
PO BOX 786
MILTON WA 98354
MILTON WA 98354
Additional Permit Information
la this an Online or O.T.C. application? ..................
Electrical Fixtures
Circuits - Residential 6
PERMIT EXPIRES Thu>c1�, February, 2
Permit Issued on Wedne�sda�FebruarY l9 0
•
1 hereby certify that the above information is !�Q(Vd that the constryc n on the above described property
and the occupancy and the use will be in nce with the la ules and regulations of the State of
ashington and the City of Fed ay.
Owner or agent: Date: �ZO
4b
_�k
CITY OF
Federal Way
THIS CARD IS TO REMAIN ON -SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050 _
PERMIT #: 20 100721 00 Address: 4129 SW 328TH ST
Project: MARIA PAULA BAERENWALD FEDERAL WAY WA 98023-2628
Scheduled inspections maybe failed if this card is not on -site. DO NOT LOSL 'I'll IS 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) Q Ditch cover (4030) ❑ Slab/Concrete Floor (4255)
Approved Approved Approved to place concrete
By Date By Date By Date
Q Pool Bonding (4195)
❑ Temporary Power (4275)
❑ Service (4235)
Approved
Approved
Approved
By Date
By Date
By le Date
0 Feeders/Sub-panels (4045)
❑ Rough Electrical (4225)
❑
Ceiling Cover (4020)
Approved
Al rm'cd
Approved
By
Date
By
Date _�?,
By
Date
t , Final - Electrical (4055)
Approved
By Date
❑
Rough Electrical
❑
Final Electrical
❑
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF 4A
Federal Way
RECEIVE®
FEB 19 2020
CITY OF FEDERAL WAY
COMMUNfTY DEVELOPMENT
ELECTRICAL
PERMIT APPLICATION
PERMIT NUMBER —A 0 _ 1 V _ 1
SITE ADDRESS: �1261
SUITE/UNIT/SPACE #
CURRENT/PROPOSED USE
PROJECT VALUATION ASSESSOR'S TAX/PARCEL # �
(I /
�(D - i
PROJECT NAME
(Tenant or Homeowner Last Name)
e (�
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS _1
E-MAIL
cj"a I
S
ZI�'��
/ ����
) FAX
1
NAME
f3/1 )x//
PRIMARY PHONE
MAILING ADDRESS
? Q ��
E-MAIL
ELECTRICAL
7
CITY (,' /
S T
ZIP �
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
Sul PgEF gur
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS A/R
E-MAIL
CITY S E ZIP
NAME� G
FAX
PROJECT CONTACT
PRIMARIJONE
�j r)�zY P�79 9"
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 a reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci _tbde appticatiati:'
SIGNATURE: DATE
PRINT NAME: f v�
Bulletin # 160 — April 14, 2016 Page 1 of 1 kAHandouts\Electrical Permit Application