15-101974 Electrical
City of&Federal.Dev. y
S Permit #: 15-101974-00-EL
Community&Econ.Dev.Services
33325 8th Ave S
Federal Way,Fax
98003 Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: LAKEHAVEN UTILITIES-WATER SHOP BUILDING
Project Address: 31623 1ST AVE S Parcel Number: 072104 9017
Project Description: Run electrical for(2) readers and (2)operators plus control circuits.
Owner Applicant Contractor
LAKEHAVEN UTILITY DISTRICT GARY COOK OWNER IS CONTRACTOR
PO BOX 4249 LAKEHAVEN UTILITY DISTRICT
FEDERAL WAY WA 98063 3203 S DASH POINT RD
FEDERAL WAY WA 98023
Additional Permit Information
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 4
PERMIT EXPIRES Tuesday, October 20, 2015
Permit Issued on Thursday, April 23, 2015
I hereby certify that the above information is correct ..,„that the construction on the above described property and
the occupancy and the use will be in accordanc= he laws, rules and regulations of the State of Washington
a = 'i •f Federal Way.
Owner or agent: �� Date: t i r
DATE INSPECTOI ) AREA AND TYPE (INSPECTION
aU
..m.,, .,'"-41A4,. THIS CARD IS TO .MAIN ON-SITE
"TM OF 110 Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 15-101974-00-EL Address: 31623 1ST AVE S
Project: LAKEHAVEN UTILITY DISTRICT FEDERAL WAY, WA 98003
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.
❑ UFER Ground (4295) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date '1. I ZZ I IS By Date
o Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
❑ Feeders/Sub-panels(4045) ❑ Rough Electrical (4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
o Final-Electrical(4055)
Approved
B 5. _ Date ck _ l— I S—
❑ Rough ElectricalCI Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
,
•EIVED •
CITY OF 1‘,P.- 2 3 2015 ELECTRICAL
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
C - 10 ( 97 - �-
PERMIT NUMBER
1
SUITE/UNIT/SPACE#
SITE ADDRESS: 3,6 / S� „4-/_/i-_
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# ( CURRENT/PROPOSED USE
$ 3),0z2 02 A ( - d (
PROJECT NAME
(Tenant or Homeowner Last Name) e1,1)4.-/���� f 2''
PROJECT DESCRIPTION 2 cAg',2.---7!�� ,-,e9.4‘.<5 Ce9/1/17e'`it.:-'
Detailed description of work to (-7.4 v?C r/s i7
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Z-V)164/141-v2v 77‘-, ,7y 9/Si (Z)-39y/-/576i
MAILING ADDRESS E-MAIL
z'v 67akje
CITY STATE ZIP FAX
G✓4- ilece5 ( )
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
._.. NAME PRIMARY PHONE
APPLICANT < `` (2) 9rf r rMAILING ADD S E-MAIL
3 5 ;v � 1�
CITY STATE ZIP FAX
6J ' 61,9- �/�023 ( S)f>%2-�"7
NAME PRIMARY PHONE
PROJECT CONTACT ,n
«lam (2-F3) -6665
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 ••rt •f this application.
SIGNATURE: �-.1d /L DATE
PRINT NAME: / %� C'eXEC.,
Bulletin#160—January 1,2013 Page 1 of 2 k:\Handouts\Electrical Permit Application