14-102693City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
FILE
Project Name: LAKEHAVEN 20TH AVENUE TANK
Electrical
Permit #: 14 -102693=00 -EL
Inspection Request Line: (253) 835-3050
Project Address: S 300TH ST Parcel Number: 042104 9169
Project Description: Addition of (1) 20 amp/120 volt AC circuit for mixer installation.
Own
ARRlican
Contractor
LAKEHAVEN UTILITY DISTRICT
LAKEHAVEN UTILITY DISTRICT
LAKEHAVEN UTILITY DISTRICT
PO BOX 4249
PO BOX 4249
PO BOX 4249
FEDERAL WAY WA 98063
FEDERAL WAY WA 98063
FEDERAL WAY WA 98063
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 .................... 1
PERMIT EXPIRES Saturday, December 6, 2014
Permit Issued on Monday, June 9, 2014
1 hereby certify that the above information ' co ct d that the construction on the above described property and
the occupancy and the use will in nce th the laws, rules and regulations of the State of Washington
an a City of Federal Way.
Owner or agent: Date:
VAi� TS CARD IS TO REMAIN ON-SITE
FedHI
eral WayConstruction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 14 -102693 -00 -EL Address: S 300TH ST
Project: LAKEHAVEN UTILITY DISTRICT FEDERAL WAY, WA
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.
C
By Vwj
h cover
Approved
■❑
Date (0 6 11 1 i't I I By
Final - Electrical (4055)
Approved
By Date V
Approved
Date
By Date
Rough Electrical
Approved
Final Electrical
Right of Way
Approved
Approved
By
Date
By
Date
By
Date
clrr of A
• EL CTRICAL
Federal Way PERMIT AP8b TION
PERMIT NUMBER OD JUN 0 9 2014 1�1
CITY OF FEDERAL WAY
SITE ADDRESS: Tj �%f`
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3 C ��.� S- j —
s IT/SPACE +t
PROJECT VALUATION
ASSESSOR'S TAXIPARCEL i
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
�L�
PRIMARY PHONE
(� ) / - /%
MADdNG ADDRESS
� L
CITY CC --
STATE
ZIP
FAX
NAME
PRIMARY PHONE
)
MAILING ADDRESS
�MAII,
ELECTRICAL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE X EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE A
APPLICANT
NAME
�Z
PRIMARY PHONE
o—_?) N r
MAILING ADDRESS
&3 e,? --i /: 0 s >
E-MAIy
CI
STATE I
ZZP2
' � FAX ^�
PROJECT CONTACT
NAME
��2
PRIMARY PHONE
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 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 War to y claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which ma a made any person, including the undersigned, and filed against the city,
but only where such claim arises out of the a of the ci , including its officers and employees, upon the accuracy of the
information supplied to the city as a pg�t o his licaton
SIGNATURE:
PRINT NAME
Bulletin # 160 —January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application