15-100405t
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City of Federal Way
LAKEHAVEN UTILITY DISTRICT
Community & Econ. Dev. Services
33325 8th Ave S
LAKEHAVEN UTILITY DISTRICT
Federal Way, WA 98003
FILE
Ph: (253) 835-2607 Fax: (253) 835-2609
FEDERAL WAY WA 98063
Project Name: LAREHAVEN UTILITY DISTRICT
Project Address: S 300TH ST
0 Eleetrical
Permit #: 15 -10046 -5 -00' -EL
Inspection Request Line: (253) 835-3050
Project Description: Addition of (1) 20 amp/120 volt AC circuit for mixer installation.
Parcel Number: 042104 9169
Owner
A uln icant
Contractor
PHIL STRYKER
PHIL STRYKER
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
Service greater than 999 Amps? .............................No
Electrical Fixtures
Circuits - Commercial. ...................
Is Use Educational or Institutional? ....................... No
PERMIT EXPIRES Sunday, July 26, 2015
Permit Issued on Tuesday, January 27, 2015
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
nd the City of Federal Way.
Owner or agent: Date: 65—
CITY OF
Federal Way
PERMIT #:
Project:
15 -100405 -00 -EL
PHIL STRYKER
THIS CARD IS TOMAIN ON-SITE
Construction In ection Record
INSPECTION REQUE TS: (253) 835-3050
Address: S 300TH ST
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.
Pool Bonding (4195)
Approved
By Date
Temporary Power (4275)
Approved
By Date
UFER Ground ( 95)
Ditch cover (4030)
By
Slab/Concrete Floor (4255)
0
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Pool Bonding (4195)
Approved
By Date
Temporary Power (4275)
Approved
By Date
❑
Service (4235)
Approved
By
Date
❑
Feeders/Sub-panels (4045)
❑
Rough Electrical (4225)
0
Ceiling Cover (4020)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved1:1
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITU OF A
Federal Way
PERMIT NUMBER l S_
JAN 2 7 2015
ELECTRICAL
PERMIT APPLICATION
CITY OF FEDERAL WAY
o EL
SITE ADDRESS:AVZ
S
SUITE/UNIT/SPACE #
PROJECT VALUATION
$1 Loo - -
ASSESSOR'S TAR/PARCEL #
0 y 2 -
CURRENT/PROPOSED USE
PROJECT
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAYS
LAKE-4pa tJ ov
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PRIAfARY PRONE
NAILING ADDRESS
S-MAII.
CITY
STATEZD'
FAX
NAME
PRDRARY PRONE
MAILING ADDRESS
&MAIL
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
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PRIMARY PHONE
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MAILING ADDRESS�/ II
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STATE
ZIP
FAX
PROJECT CONTACT
AY
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(-253)a(0i - 5
I certify under penalty of perjury that I am the property owner or authorised 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 offtcers and employees, upon the accuracy of the
information supplied to the city as apart of this application.
SIGNATURE: DATE / -2 i 5
PRINT NAME:
Bulletin #160 —January 1, 2013 Page 1 of 2 k: flandoutsTlectrical Permit Application