19-102536 Electrical
City of Federal Way Permit #:19-102536-00-EL
Community Development Dept
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: LAKEHAVEN UTILITY DISTRICT
Project Address: 31627 1ST AVE S Parcel Number:072104 9017
Project Description: Retrofit(8)existing can lights with LED upgrades.Replace(4)existing flood lights with LED
upgrades.Replace(6)flood lamp bulbs with LED.
Owner Applicant Contractor
LAKE HAVEN UTILITY DISTRICT KEITH BOURQUINLAKEHAVEN UTILITY OWNER IS CONTRACTOR
PO BOX 4249 DISTRICT
FEDERAL WAY WA 31623 1ST AVE S
98063 FEDERAL WAY WA 98003
Additional Permit Information
Is this an Online or O.T.C.application Yes
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PERMIT EXPIRES Saturday,23 May,2020
Permit Issued on Friday,May 24,2019
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
shington and the City of Federal Way.
Owner or agent: g� Date:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
FeClerai way INSPECTION REQUESTS:(253)835-3050 ,
PERMIT#: 19 102536 00 Address: 31627 1ST AVE S
Project: OWNER IS CONTRACTOR FEDERAL WAY WA 98003-5201
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.
LIFER Ground(4295) 0Ditcb cover(4030) I:I Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved 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
.
El Final-Electrical(4055)
proved
By 1/P
Date 6 r)y-//
g
•
Rough Electrical 0 Final Electrical [J Right of Way
Approved Approved Approved
By Date By Date By Date
RECEIVED ELECTRICAL
CITY OF A
Federal Way MAY 1' 2019 PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT ( S
PERMIT NUMBER / _ I C) 2 5 G _ C c_.
SITE ADDRESS: SUITE/UNIT/SPACE•
-51 6, Ii' �v S �IN
PROJECT VALUATION ASSESSOR'S TAX/PARCEL t CURRENT/PROPOSED USE
PROJECT NAME ,) ' 1 1 1 1
(Tenant or Homeowner Last Name) �,IIAw 1.^ 1}1) 0 l eni f '. jcbl) i ow v-i 4 T AlrOA i,
PROJECT DESCRIPTION ^t1V�- - 1,�� 1S r &Nr 1•�)5 w1A� ,L` q I`'tAlG.4
Detailed description of work to 1v14be L� .�� j f�O I, L,`'10,, tANAIN Vcf e c
be included on this permit only 6 4t_ (_1 vi
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PRIMARY PHONE
PROPERTY OWNER X53 1�i� 1;16
MAILING
316x•7 ADDRESS144' NV4. S(:1 h w‘4*)114pcn Jail
CI 1 STATE ZIP FAX
<A1 W I�JA (1%1)03 ( )
NAMENAME PRIMARY PHONE
( )
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY EIISINESS LICENSE#
/ /
NAME . I PRIMARY PHONE
APPLICANT t\Ck�h 6SOUi WA 1Y\ GS3 )ab) -67'
MAILING ADDRESS 1ZIP f
3aD Pas/, 4 /' gek Ki rb u►11n itikeh til.pr
4.61/DA
BT TE F 1
NAME PRIMARY PHONE
PROJECT CONTACT
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 arty 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 ci; as a part of this application.
SIGNATURE: � ill iI _ DATE 6 Ji y 1I
PRINT NAME: N L1 DIA tR,W
PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607+ FAX 253-835-2609 + permitcenter@a,cityoffederalway.com
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application