11-103744City of Federal Way •
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609
0 Eltetrical
Permit #: 11- 103744 -00 -EL
Inspection Request Line: (253) 835 -3050
Project Name: LAKEHAVEN WELL #19 FERRIC CHLORIDE SYSTEM
Project Address: 750 SW CAMPUS DR
Project Description: Alter a circuit to power new injection pump (single-phase, 120V)
Parcel Number: 192104 2007
Own r
Applicant
Contractor
LAKEHAVEN UTILITY DISTRICT
LAKEHAVEN UTILITY DISTRICT
LAKEHAVEN UTILITY DISTRICT
PO BOX 4249
PO BOX 4249
PO BOX 4249
FEDERAL WAY WA 98063 -4249
FEDERAL WAY WA 98063 -4249
FEDERAL WAY WA 98063 -4249
Is Use Educational or Institutional ? .......................No
Circuits - Commercial .................... 1
Service greater than 999 Amps? .............................No
PERMIT EXPIRES Friday, September 14, 2012
Permit Issued "bn Thursday, September 15, 2011
I hereby certify that the above information is cor nd that the construction on the above described property and
the occupancy and the use will be ccord with a laws, rules and regulations of the State of Washington
t of Federal Way.
Owner or agent: Date: 1
�., 2
THIS CARD IS T MAIN ON -SITE
crrxor Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835 -3050
PERMIT #: 11- 103744 -00 -EL Address: 750 SW CAMPUS DR
Project: LAKEHAVEN UTILITY DISTRICT FEDERAL WAY, WA
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.
Rough Electrical (4225) Final - Electrical (4055)
Approved Approved
By Date I I By „ 1 Date c .—
0
Rough Electrical
Approved
Final Electrical
Approved
❑
Right of Way
Approved
By
Date
By
Date
By
Date
�_, -�rv� sL L� � �4
CITY " U.-
Federal ,ELECTRICAL
Pw%"� T APPLICATION
CjTy OF FE6j'ET,
"Most e0&alpermits may be obtained on-line at www-cityqf e ra COM**
f
SITE ADDRESS: 7f-V Sc,-J � l-us 0<-,
SUITE /UNIT /SPACE # VASSESSOR'S TAX/PARCEL # F
_7 CURRENT/PROPOSED USE
PROJECT NAME
/Tenant or Homeowner Last Name) E_ /�I✓J 10 W
PROJECT DESCRIPTIO
Detailed description of work to
be included on this permit only
PROPERTY OWNER
ELECTRICAL
CONTRACTOR
APPLICANT
PROJECT CONTACT
;M(
SAM
PRI31ART PHONE
SKAHJUG ADDRESS
A,, 4CIX 4� ce Vf
,Crr!r
STATE
ZIP
FAX
WABW
PRI31ART PHONE
KAHjM'ADDRZSS
CrTY
STATE T
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE • EXPIRATION DATE
FEDERAL WAY. BUSUMSS LXCZNS& •
L
—
NAME
PRIAMRT PHONE
qyj' " ry),
F—KAIL
04111- 41
_0 ekVA_
Crry
STATE
ZIP C.0,
FAX
NAME
PR131ARr PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certib that to the best
of my knowledge, the information suhmitted In support of this permit application is true and correct. I certqg that r will comply with
all applicable City of Federal Way regKiations, 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
Ifurther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys'fiess, incurred in
the investigation and defense of such claim), which may be made by ajyjqqrsan, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the cit�knclu Iftcers and employees, upon the accuracy of the
Png its o
information supplied to the city as apart of this application.
SIGNATURM
PRINT NAME-
TE
33325 e Avenue South + Federal Wav # WA # 98003-6325 1253- 835 -26071 fax: 253-935-2609 + "-w.citvoffcdcralway.coM