18-102375ANr Is
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5
Electrical
City of Federal Way Permit #:18 -102375 -00 -EL
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003 Inspection Request Line: (253) 835-3050
Ph: (253) 6352607 Fax (253) 835-2609
Project Name: LAKOTA SEWAGE TREATMENT. PLANT
Project Address: 3203 SW DASH POINT RD Parcel Number: 122103 9105
Project Description: Terminate wiring in (6) sludge finder control panels, includes installing (1) 30A circuit 120V
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
Is this an Online or O.T.C. application? .................. Yes
Circuits - Commercial 1
PERMIT EXPIRES Saturday,1 June, 2019
Permit Issued on Friday, June 1, 2018
I hereby certify that the above informatio d that the construction on the above described property
and the occupancy and the use wi ' a r nce with the laws, rules and regulations of the State of
a g a the City of Federal Way.
Owner or agent: Date: e:;//
w -
THIS CARD IS TO REMAIN ON-SITE
CrrV OF Construction Inspection Record
Fee eral Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18102375 00 Address: 3203 SW DASH POINT RD
Project: LAKEHAVEN UTILITY DISTRICT FEDERAL WAY WA 98023-2340
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.
E
UFER Ground (4295)
®
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
®
Pool Bonding (4195)
®
Temporary Power (4275)
®
Service (4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
®
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
0
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
10 Final - Electrical (4055)
Approved
By 1 Date
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF 'A
Federal Way
RECEIVED ELECTRICAL
JUN 01 2018 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNRY DEVELOPMENT pr O Z aQ
PERMIT NUMBER D
"00I 0
Jt
SUITE/UNIT/SPACE «
SITE ADDRESS:
A � G✓ ^� ^ .� �j
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PROJECT VALUATION
ASSSE SOR'S AX/PAR E L N O7. 0
2 LJ—
CURRENT/PROPOSED USE
$ :5.0% VOO . 00
PROJECT NAME
I
L- K-
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
2 ✓
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
1ro-s -
t2+3) gy/ - < i 6
MAILING ADDRESS
Z-M,&IL
'00o
CITY
STATE
ZIP
FAX
NAMEPRIMARY
PHONE
-
MAILING ADDRESS
E-MAIL
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
t ) -
WA STATE CONTRACTOR'S LICENSE A EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE 8
NAME
PRIMARY PHONE
aIL 6G
APPLICANT
MAILING ADDRES
X-M
ZO 3 f "W fa/tTiSL A i 4-�>
CITY
moo -- a
STATEZIP
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9'8vz3
FAX
PROJECT CONTACT
NAME
� ,� 6ev 4--,
PRIMARY PHONE
(&3)e -l; 3
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, whic be de by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the fiance city, including its officers and employees, upon the accuracy of the
information sunalied to the cite as a peF'Po is ap n.
SIGNATURE:
PRINT NAME:
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permiteenter@cityoffederalway.com
Bulletin #160 – April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application