15-10458231ty of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003..
Ph: (253) 835-2607 Fax: (253) 835-2609
0
Electrical
Permit #: 15 -104582 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: LAKEHAVEN UTILITY DISTRICT SOUTH BEACH SIPHON
Project Address: 320 SW 292ND ST
Parcel Number: 119600 0265
Project Description: ALT - Relocate telementry panel and add new conduit to existing wet well
Owner
A Ip iv cant
Contractor
LESLIE S ALLMENDINGER
LAKEHAVEN UTILITY DISTRICT
LAKEHAVEN UTILITY DISTRICT
4726 49TH AVE S
3203 SW DASH POINT RD
3203 SW DASH POINT RD
SEATTLE WA 98118
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C. application?.................Yes
Electrical Fixtures
Circuits - Residential ...................... 1
Is Use Educational or Institutional?.......................No
PERMIT EXPIRES Tuesday, March 8, 2016
Permit Issued on Thursday, September 10, 2015
I hereby certify that the above information is correct and that ft construction on the above described property and
the occupancy and the use will be in accordance wit a laws, les and regulations of the State of Washington
a the C of F al Way.
Owner or agent: Date:
t`
CITY OF 40;&
Federal Way
PERMIT #:
Project:
THIS CARD IS TOREQ� ON-SITE -
Construction Inspeon Record
INSPECTION REQUESTS: (253) 835-3050
15 -104582 -00 -EL Address: 320 SW 292ND ST
LESLIE S ALLMENDINGER FEDERAL WAY, WA 98023-3523
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
Date
F1
UFER Ground (4295)Ditch
cover (4030)
❑
Slab/Concrete Floor (4255)
Approved
Approved
By
Approved to place concrete
By
Datea
Dat�'.L _ l . _ �—
By
Date
Final - Electrical (4055)
Approved
Date
F1
Pool Bonding (4195)
❑
Temporary Power (4275)
❑
Service (4235)
By
Approved
By
Approved
By
Approved
By
Date
By
Date
By
Date
0
Feeders/Sub-panels (4045)
Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
Date
F1
Rough Electrical
Approved
❑
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
ELECTRICAL
3Z�, I� i•
- �� Oo SEP 0 9 2015
PERMIT NUMBER � � i
CITY OF FEDERAL WAY
SITE ADDRESS: �z
SUITE/UNIT/ #
PROJECT VALUATION
O� O
ASSESSOR'S TA�ARCEL # � O � � � r�
`j1 _ J
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
&yyy Dt{ t '� �O w Ev—
C
PROPERTY OWNER
NAME
C `- (,Ll
PRIMARY PHONE
053)2& I -5-778
MAILING ADDRESS
3�3 s� qhs14 P/
E-MAIL.
CITY
W
STATE
WA --
ZIP
FAX
ELECTRICAL
CONTRACTOR
NAME
( PRIMARY PHONE
1 )
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
/ - �7v
MAILING ADDRESS
E-MAIL
CITY
STATE
I ZIP
/ FAX
)
PROJECT CONTACT
NAME
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 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. f
SIGNATURE: DATE
PRINT NAME:�L L�Pi1GdcS �✓
Bulletin # 160 — January 1, 2013 Page i of 2 Ul IandoutsTlectrical Permit Application
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