15-106385City 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: LAKOTA MAINTENANCE BUILDING
Project Address: 3203 SW DASH POINT RD
.ectrical
Permit #: 15 -106385 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 122103 9105
Project Description: Installation of APU plug and required disconnects & transfer switches.
Owner
ARRlicant
Contractor
LAKEHAVEN UTILITY DISTRICT
GARY COOK
OWNER IS CONTRACTOR
PO BOX 4249
LAKEHAVEN UTILITY DISTRICT
FEDERAL WAY WA 98063
3203 S DASH POINT RD
FEDERAL WAY WA 98023
Additional Permit Information
Electrical Work Valuation?....................................7500 Is this an Online or O.T.C. application? ................. Yes
Is Use Educational or Institutional?.......................No Service greater than 999 Amps? ............................. No
Electrical Fixtures
Alt. Srvc / Feeder 0 to 200 amps (C 1
PERMIT EXPIRES Tuesday, June 14, 2016
Permit Issued on Thursday, December 17, 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
and the City of Federal Way.
Owner or agent: ADate:
� c
s;�kGSt.
_ 3
'Z �✓ TW u� Tl+li-w
u
i
THIS CARD IS TO REMAIN ON-SITE
0" OF Copstruction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #:
15 -106385 -00 -EL 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.
Final - Electrical (4055)
Approved
By Date
UFER Ground (4295)El
Ditch cover (4030)
Temporary Power (4275)Service
Slab/Concrete Floor (4255)
Approved
By
Approved
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Pool Bonding (4195)
0
Temporary Power (4275)Service
(4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date 01 _ 2( t
Feeders/Sub-panels (4045)
❑
Rough Electrical (4225)
❑
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF A
Federal Way
RECEIVED
DEC 17 2015
CITY OF FEDERAL WAY
CDS
ELECTRICAL
PERMIT APPLICATION
PERMIT NUMBER
'3�%3 5'r v 04SIT / T
SITE ADDRESS: ^�✓^'
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S TAX/IfARCEL #
CURRENT/PROPOSIfD USE
PROJECT NAME
(Tenant or Homeowner Last Name)
��Ou ,PLtr, r,, /N'f / O /✓
PROJECT DESCRIPTION DESCRIPTION
Detailed description of work to
be included on this permit only
2L_
m lF
;,,
PROPERTY OWNER
NAME
127Z, r
PRIMARY PRONE
(yrs)
MADdNO ADDRESS
.,� O _S0�7JC
EMAIL
CITY
Fg-
STATE
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
PRIMARY PRONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # ERPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PRONE
(j) 9f) --/)--f1-
MAILING ADDRESS
E-MAIL
CITY''
STATE
ZIP p+�
FAX
(2t-fGJ) - Or -V7
PROJECT CONTACT
NAME
„�� �Gt�/L
PRIMARY
(2JI) -- Na
G G 3
I certib under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert{fy that to the best
of my knowledge, the injbrmation 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 jfurther 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 be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out oft anc of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a par f t app ation.
E71C01LV0Tt1A
PRINT
Bulletin #160 —January 1, 2013 Page I of 2 k:\Handouts\Electrical Permit Application