14-103654t 4
Annticant
Contractor
LAKEHAVEN UTILITY DISTRICT
City of Federal Way
Community& Econ. Dev. Services
LAKEHAVEN UTILITY DISTRICT
PO BOX 4249
(wLdJ
33325 8th Ave S
FEDERAL WAY WA 98063
FEDERAL WAY WA 98063
Federal Way, WA 98003
Ph: (253)835-2607 Fax: (253) 835-2609"
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Permit #: 14 -103654 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: LAKEHAVEN UTILITY DISTRICT �,�''
Project Address: 1919 S 324TH ST ( '�uj�fcel Number: 162104 9039
Project Description: Installing 2 parking lot lights and underground conduit for future security cameras.
Owner
Annticant
Contractor
LAKEHAVEN UTILITY DISTRICT
J f / �j�
LAKEHAVEN UTILITY DISTRICT
PO BOX 4249
(wLdJ
PO BOX 4249 .
FEDERAL WAY WA 98063
FEDERAL WAY WA 98063
Additional Permit information
Is this an Online or O.T.C. application?.................Yes
Service greater than 999 Amps? .............................No
Circuits - Commercial. ................... 1
Is Use Educational or Institutional?.......................No
PERMIT EXPIRES Sunday, January 18, 2015
Permit Issued on Tuesday, July 22, 2014
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
the City o ederal Way.
Owner or agent: Date:G�`"��
CITY OFA
Federal Way
THIS CARD IS TOMAIN ON-SITE•
Construction In ection Record
INSPECTION REQU TS: (253) 835-3050
PERMIT #: 14 -103654 -00 -EL Address: 1919 S 324TH ST
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)
Feeders/Sub-panels (4045)
Slab/Concrete Floor (4255)
1:1Approved
Approved
By
Approved
Approved
Approved to place concrete
By
Date
By
Date s), _, 6
By
Date
Service (4235)
1:1Approved
Feeders/Sub-panels (4045)
Rough Electrical (4225)
1:1Approved
Approved
By
Date
Approved
Approved
By
Date 2 s -
By
By
Date
By Date
Ceiling Cover (4020)Final
- Electrical (4055)
Approved
Approved
By
Date
By
Date
Rough Electrical
Approved
1:1Approved
Final Electrical
1:1Approved
Right of Way
By
Date
By
Date
By
Date
CffyOF.&
JUL 212014 ELECTRICAL
Federal Way CITY OF FEDERAL WAY PERMIT APPLICATION
CDS
PERMIT NUMBER
SITE ADDRESS: i fts A V6-. + 5y32- �'�
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL #
CURRENT/PROPOSED USE
%
PROJECT NAME
(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
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Detailed description of work to
be included on this permit only
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.....,�..____...�—..r._.._..�...�_
PROPERTY OWNER
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NAME
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PRIMARY PHONE
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E-MAIL
FAX
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NAMEPRIMARY
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PHONE
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NG ADDRESS
E-MAIL
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CITY
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WA
ZIP
1616
FAX
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CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
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PRIMARY PHONE
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CITY
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ZIP
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PROJECT CONTACT
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PRIMARY PHONE
S3)40 C-1- f
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(& that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I cert(& 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 claing, which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises t of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the cJt& as p f his application. %
SIGNATURE: G" DATE <
PRINT NAME:
Bulletin #160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application