09-102618Electrical
City of Federal Way
Community Development Services Permit #: 09 -102618 -00 -EL
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: 253 83
Ph: (253) 835-2607 Fax: (253) 835-2609 FILt
p q ( ) 5-3050
Project Name: BETHEL CHRISTIAN CHURCH
Project Address: 125 SW MIRROR LAKE PARK Parcel Number: 072104 9003
Project Description: Replace 200 -amp panel.
Owner
Applicant
Contractor
BETHEL CHRISTIAN CENTER
LINDSAY ELECTRIC
LINDSAY ELECTRIC
414 SW 312TH PL
163 MIRROR LAKE PARK
LINDSE*021JG (3/31/11)
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
163 MIRROR LAKE PARK
FEDERAL WAY WA 98023
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Is Use Educational or Institutional?.......................No
CITY of ' V A
Federal Way
THIS CARD IS TO MAIN ON-SITE
Construction I ection Record
INSPECTION REQU TS: (253) 835-3050
PERMIT #: 09 -102618 -00 -EL Address: 125 SW MIRROR LAKE PARK
Owner: BETHEL CHRISTIAN CENTER 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.
For infector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
LIFER Ground (4295)13
Pool Bonding (4195)
Ditch cover (40 0)
Slab/Concrete Floor (4255)
Approved
Service (4235)
Approved
Approved to place concrete
By
Date
By
Date
By
Date
For infector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
Pool Bonding (4195)
Temporary Power (4275)
Service (4235)
Approved
Approved
Approved
By
Date
By
Date
By
Date
E]
❑
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
For infector reference only
❑ Rough Electrical ❑ FINAL - Electrical
Approved Approved
By Date By Date
Fede EIVEIPPERMIT S F CO ME &L) PL DE E FP
CONWMTY DgVEWPAWM SEMM APPLICATION
L 10 20x0
SITE ADDM —
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SUITE/UNIT iZONIIid ASSESSOR'S TAS/ A== •
RAMS OF PROJECT/� �f
jTenant or Homeowner Name) 91 Y
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION XELECTRICAL ❑ ENGUFEER1NG ❑ FIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit onry
PROPERTY OWNER
NAUJNG ADDRESS, CITY, STATE, ZIP
PRUMARY PHONE
(2'5"3) $3f~r.U4-
E-MAH.
OWNER IS ALSO:
0 CONTRACTOR ❑
APPLICANT
O PROJECT CONTACT
NAM
L rlGt aP dr 1
FRnEARYPHONS
Z 66 L/ S
CONTRACTOR
MAUjxa ADDREas, crry, STATE, ZIP
/&q /t4r moor L �
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FAX
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FEDERAL WAY SUSM= LICENSE
WA STATE CONTRAC//TOR's LICENSE # ESP3RATION DATE
Lin C (j 2�.Tlr � /�1
APPLICANT
NAME �
�`✓��
PRDMAR: rHONE
-
FAX
KAUJNG ADDRAW. CITY, STATE, UP
PROJECT CONTACT
NA=
FRUEARY PHONE
(The individual to receive and
-
respond to all Correspondence
concerning this application
MAHJNG ADDRESS, CITY, STATE, ZIP
FAX
ALTERNATE CONTACT NAME:
it
PRDIARY PRONE
E•MAU,
t -
PROJECT FINANCENG
Required for p%)ects with
value of $5,000 or more
(RCW 19.27.095)
NAME
MAII.INO ADDRESS, CITY, STATE, ZIP
A
PRUMARY PHONE
beat of my knowledge, tunder he own thatZ am ttted ithe ��q3port of owner or authorised agent of the property owner. I ce tVy that to the
comply
with all applicable City of Federal Way regulations pertaining to s authopermit rized by the issuancn is true and e of a permit. that
and that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
conduction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, wepenses, and attorneys' fees incurred
in the investigation and defense of such claim), which m y 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 gaicers and employees, upon the accuracy of the
injormation supplied to the citas a part of this application.
SIGNATURE:
PRINT NAME:
Bulletin # 100 — 4/17/2009
Page I of 4
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