17-106126City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253) 8352609
Electrical
Permit #:17 -106126 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: LAKOTA SEWAGE TREATMENT -DIGESTER BUILDING
Project Address: 3203 SW DASH POINT RD
Parcel Number: 122103 9105
Project Description: Adding (1) circuit 110VAC -20 amp and analog wiring to remote UO panel
Owner
Applicant
Contractor
i AKRHAVEN 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 Low Voltage - Other (Commel 1
PERMIT EXPIRES Saturday, 29 December, 2018
Permit Issued on Friday, December 29, 2017
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 and the City of Federal Way.
Owner or agent: Date: d�
THIS CARD IS TO REMAIN ON-SITE y
10;&
FedeWay Construction Inspection Record
. INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 1710612600 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.
Feeders/Sub-panels (4045)
LIFER Ground (4295)
0
Ditch cover (4030)
0
Slab/Concrete Floor (4255)
Approved
Approved
Approved
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
Pool Bonding (4195)
s❑
Temporary Power (4275)
®
Service (4235)
Approved
Approved
Approved
Approved
Approved
ay
Date
By
Date
By
Date
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
Final Electrical
Ceiling Cover (4020)
Approved
Right of Way
Approved
Approved
Approved
By Date
By
Date
Approved
By
Date
Final - Electrical (4055)
Approved
By Date t%
Rough Electrical
Final Electrical
❑
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
>� of
RECEIVED
Federal Way DEC 2 g 2017
ELEC'T'RICAL
PERMIT APPLICATION
CITY OF FEDERAL WAY( 2 /
MMUNI.IY DEVELOPMENT PERMIT NUMBER ( / lIJ
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SITE ADDRESS' ✓� �� <t J► /
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SUITE/UNIT/SPACE #
PROJECT VALUATION
500
ASSESSOR'S TVV�
XA/PARCEL #
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CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work toI
be included on this permit only
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PROPERTY OWNER
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PRIMARY PHONE
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FAX
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PRIMARY PHONE
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MAILING ADDRESS
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CONTRACTOR
WA STATE CONTRACT
'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
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PRIMARY PHONE
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MAILING ADDRESS
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PROJECT CONTACT
NAME
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PRIMARY PHONE
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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 apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin #160 —April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application