HomeMy WebLinkAbout16-101736 •
' ' -Electrical
City of Federal Way Permit #: 16-101736-00-E L
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2807 Fax:(253)835-2809 p
Project Name: MIRROR LAKE VILLAGE SENIOR HOUSING BLDG A
Project-Address: 836 SW 312TH 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
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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(Col I
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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: Date:
THIS CARD IS TO REMAIN ON-SITE
CITY OF 411;01444. 4,1111*.... ' � � .� _ 1
Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 16-101736-00-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.
0 UFER Ground (4295) ❑ Ditch cover(4030) " 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By e.--SAr...)- Date 5-N1--1,1• By Date By t.„ v Date
0 Pool Bonding(4195) El Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By 12,e_ Date//HHY'17
O Feeders/Sub-panels(4045) 0 Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By /-0 Date 7,`'7 - (9 By Date
O Final-Electrical(4055)
Approved
By r____L Date ( I95 I i, ,
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O Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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CITY of •
APR 07 2016 ELECTRICAL
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
( CDS
PERMIT NUMBER7 r
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SUITE/UNIT/SPACE#
SITE ADDRESS: 8 LJ\x/ -2. --r-rt.... S.T,eli-E: A-
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# l _ 7 CURRENT/PROPOSED USE
$ Z �( L _90 T
PROJECT NAME
(Tenant or Homeowner Last Name) t��Q 2 LA.K_t V I LL, -
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PROJECT DESCRIPTION i t'-- o kJ r- Cl-- LI vt.u a-‘„�t If•Ou ti ci r 6-c � ,
Detailed description of work to 1
be included on this permit only �� US-
A() O e' Al-5 I
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NAME PRIMARY PHONE
PROPERTY OWNER r� 1 eeOvz . L-.,4Ke_ V I 1 l L LLC- (�Zi 5OZ- (t 3
MAIL G ADDRESS E-MAIL
CITY STATE ZIP FAA�t
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NAME PRIMARY PHONE
1-'1*Qln(AkLI G$-1-rEe_ 1E1 61'g.tc_6-1\61..) (262')0 evg_ 5b -6-
MAILING ADDRESS E-MAIL
ELECTRICAL ii 1®C( &4,1k 4L0 vo 40.Ye.s@Ace, "riL-,LO w1
CONTRACTOR CITY STATE ZIP FAX
-FvA.u_LD P \\I A- c\?_)3'R ( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME PRIMARY PHONE
APPLICANT CA.1..�1 JD2-Da IJ A`z6cx, k G, (4 -3(Z-3
MAILING ADDRESS I �4 E-MAIL
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CITY 'Le3'STATE ZIP FAX
V U ' IS LWT- (+25)v+3- 4b B'q.-
NAME PRIMARY PHONE I
PROJECT CONTACT V�z_ Do v Y\ (425j,Sc1C)--2 9 D
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 Iaws 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 c__..e -i-- _)e h vi
Bulletin#160-January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application