16-103717 Electrical
City of FederalWay Permit #: 16-103717-00-EL
Community&Econ.
D
Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253)835-3050
Project Name: LAKEHAVEN UTILITIES WATER TANKS 1 &4
Project Address: 31001 8TH AVE S Parcel Number: 082104 9029
Project Description: Add(4)20-amp circuits for control panels for tank mixers&pressure transmitter.
Owner Applicant Contractor
LAKEHAVEN UTILITY DISTRICT LAKEHAVEN UTILITY DISTRICT OWNER IS CONTRACTOR
PO BOX 4249 PO BOX 4249
FEDERAL WAY WA 98063 FEDERAL WAY WA 98063
Additional Permit Information
Electrical Work Valuation? 10000 Is this an Online or O.T.C.application? Yes
Is Use Educational or Institutional'? No Service greater than 999 Amps9 No
Electrical Fixtures
Circuits-Commercial 4
PERMIT EXPIRES Tuesday, August 1, 2017
Permit Issued on Monday,August 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
yie City of Feder ay.
Owner or agent: �� / Date:PiA/
ALS
THIS CARD IS TO REMAIN ON-SITE or - -
►« Construction Ins lection Record
Federal Way INSPECTION REQIJESTS: (253)835-3050
PERMIT#: 16-103717-00-EL Address: 31001 8TH AVE S
Project: LAKEHAVEN UTILITY DISTRICT FEDERAL WAY, WA 98003-4703
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 Ieft 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.
El IJFER Ground(4295) ❑ Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date --ISS Date g_(C7—( . .By Date
❑ Pool Bonding(4195) ❑ Temporary Power(4275) C3 Service(4235)
Approved Approved Approved
By Date By Date By Date
• Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) 121Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
❑ Final-Electrical(4055)
A roved
c Datel6 Z'Z l k
Rough Electrical
Final Electrical
Right of Way
ElApproved ❑ Approved [21Approved
By Date By Date By Date
RECEIVED
AUG 01 2016 ELECTRICAL
CITY OF40/81
Federal Way CrTY OF FEDERAL WAY PERMIT APPLICATION
PERMIT NUMBER / _ / 0 3 7 / 7
SITE ADDRESS: J "J� "AV\ c� eA SUITE/UNIT/SPACE#
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
PR J CT NAME - �'l�lE, 1vP Woke': F
(Tenant or Homeowner Last Name) �`C x 4 f k i' ki .�k(�(f S C-,,^eSSj I rAncvA ;
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PROJECT DESCRIPTION 0,..k 0 4-0. $0 )9C Jt P k1`,,1 c4 k. (S S U .^e �c\.�S�,ti c' (4 .p,+''`
Detailed description of work to Cok,.\\ i \. ( c l e ` c,
_] M
, p be included on this permit only (_ (1 ,,^ 'V
NAME
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CITY STATE ZIP
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NAM/ryEy l A
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ELECTRICAL P. 0, o i, ite- Act
CONTRACTOR ITY STATEZIP FAx
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WA STATE CONTRACTO 'S LICENSW1 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE S
11 PRIMARY PHONE
APPLICANT ,,,.( 0( A VAr \^4) .L, (J ( )
MAILIN ADDRESS �(� i (? t E-MAIL
,TY STATE ZIP FAX
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PROJECT CONTACT ( ���� 0\4n ` C PRIMARY roxE
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 this plication.
SIGNATURE: / d
DATE
PRINT NAME: t(CC 1 )CXi'`Ct % \/` A l• 4) t el Vt.. (I
Bulletin#160–January 1,2013 Page 1 of 2 k_\Handouts\Electrical Permit Application