19-103780 r 1 r
Electrical
City of Federal Way Permit #:19-103780-00-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 UTILITIES WELL 23
Project Address: 407 SW 316TH ST Parcel Number:072104 9139
Project Description: Replace motor conductors and connection enclosure.
Owner Applicant Contractor
LAKEHAVEN UTILITY DISTRICT LAKEHAVEN UTILITY DISTRICT OWNER IS CONTRACTOR
PO BOX 4249 PO BOX 4249
FEDERAL WAY WA 98063 FEDERAL WAY WA 98063
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Circuits-Commercial 1
PERMIT EXPIRES Thursday,6 August,2020
Permit Issued on Wednesday,August 7,2019
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: Date: 8 7A?
/
An
THIS CARD IS TO REMAIN ON-SITE
Federal Wa Construction Inspection Record
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 103780 00 Address: 407 SW 316TH ST
Project: LAKEHAYEN UTILITY DISTRICT 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.
1❑ UFER Ground(4295) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
® Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By Date
7❑ Feeders/Sub-panels(4045) ® Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
El Final-Electrical(4055)
ved
By /f, ate1Y /7
0 Rough Electrical 0 Final Electrical [J Right of Way
Approved Approved Approved
By Date By Date By Date
ELECTRICAL
CITY OF A RECEIVED
Federal Way PERMIT APPLICATION
AUG 0 7 2019
t'OF FEDERAL WAY PERMIT NUMBER / 9 0 3 O O _ E_
:;�;;;r+?Y DEVELOPMENT .__/,
-
SUITE/UNIT/SPACE#
SITE ADDRESS:
5e-0 3/ 7-#-57—. .e) "� e,(1�y
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ `3 avo 6 7 ( o Y - g l 3 9
PROJECT NAME
(Tenant or Homeowner Last Name) Z-Z_e____2-3
PROJECT DESCRIPTION l �«"f, G/' L _ 2--7 ( 7O7 a f)vC/ -S'
Detailed description of work to ,o' ��J/ir..v-'—�,[:JiV ��v C O S1,. .._f
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER .
/fA/ GA/4-77:: --- 5- 7--e-P___ (2)---3)99�f/ - /06
AILING ADDRESS E-MAIL
A' /jt'x 92g7
CITY STATE ZIP FAX
/ _/may A41- 937vl6 ( s-3) 871(- ?s .'7
NAME PRIMARY PHONE
/� ( )
MAILING AD RESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT +�� ' HI9PJ�ER -TC�7 2io (2.53)5L - 2O 61
MAILING ADDRESS E-MAIL
32.°3 S bl9arf kaur R) sNRar vim.
CITY STATE ZIP FAX OR4
1 *3c._ (,.SAY CAA. 1$c43 ( ) -
NAMEPRIMARY PHONE
PROJECT CONTACT 7,1-4-y [ 2'�3)3 re- 2/$7
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 a part of this application.
SIGNATURE: y _ DATE e/7//9
PRINT NAME: RXE�ZI • %T�.XU
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application