16-101068 • •
Electrical
City olf Federal Way Permit #: 16 101068-00 EL
Communi &Econ.Dev.Services -
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33325 8th Ave
FILE
Federal Way,WA 98003 Request Inspection Re t Line: 253
Ph:(253)835-2607 Fax:(253)835-2609 p q )835-3050
Project Name: 21ST AVENUE S and SOUTH 312TH STREET-LAKEHAVEN PAX MIXER
Project Address: Parcel Number: CITY WIDE
Project Description: Install a 110VAC 20 amp circuit for a water tank PAX mixer
Owner Applicant Contractor
LAKEHAVEN UTILITY DISTRIC LAKEHAVEN UTILITY DISTRIC OWNER IS CONTRACTOR
PO BOX 4249 PO BOX 4249
FEDERAL WAY WA 980634249 FEDERAL WAY WA 98063-4249
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Additional Permit information
Electrical Work Valuation9 5,000 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional? No Service greater than 999 Amps? No
Electrical Fixtures
Circuits-Commercial 1
PERMIT EXPIRES Wednesday, March 1, 2017
Permit Issued on Tuesday, March 1, 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
n• ' e City of Federal Way.
Owner or agent: c Date: 03 — 0 1 /,C
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f
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• THIS CARD IS TO RE ON-SITE
°� Construction Inspeon Record r
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 16-101068-00-EL Address:
Project: LAKEHAVEN UTILITY DISTRIC ,
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 Date By Date By Date
.
0 Pool Bonding(4195) 'El Temporary Power(4275) El Service(4235)
Approved Approved Approved
By Date By Date By Date
0 Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
❑ Final-Electrical(4055)
Approved
Bye Date 3 <,
t
`t-' Rough Electrical Final Electrical
El Approved Right of Way
Approved Approved
By Date By Date By Date
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CITY OF
ELECTRICAL
Federal Way PERMIT0ARIPLICATION
PERMIT NUMBER W _ I .1 o _ a MAR O1 2016
— —
CITY OF FEDERAL WAY
CDS SUITE/UNIT/SPACE#
SITE ADDRESS:a 1 t 'K1,1..yk
PROJECT VALUATION ASSESSOR'S TAX/P CEL# t� CURRENT/PROPOSED USE
5/ 00 -
PROJECjT NAME p Ay( im
(Tenant or Homeowner Last Name) ' \ `cam l
c$c, to two`er• ( Q C itAto
PROJECT DESCRIPTION C.�NOk V\ ` L'v `/*C•X G-LA
Detailed description of work to
be included on this permit only
NAME �. ` ( PRIMARY PHONE
PROPERTY OWNER �e U 4 t( b c4,,i )� ( -
LING ADDRESS E-MAIL
t .(( trt
�f^ CITY STATE ZIP FAX
NAME �y c• PRIMARY PHONE
5CX r �'� Ck �J a(�' ( ) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PRIMARY PHONE
APPLICANT N c tip- d( \► `C!�`�,� F.'� .< ) 74 C444
MAILING ADDRESS
;X) .J CO 0:2( GJ Cl 4) C.s-A. E-MAIL
CITY STATE ZIP FAX
c.s k'iAN E -
PRIMARY PHONE
PROJECT CONTACT
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, is application.
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SIGNATURE: ' DATE t -16
PRINT NAME: 411 ` • A S Li a
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Iletin#160—January 1,2013 Page 1 of 2 k_\Handouts\Electrical Permit Application