22-102528-Permit Application-6-7-224k
CITY OF � ��
Federal Way
ELECTRICAL
PERMIT APPLICATION
PERMIT NUMBER
SUITE/UNIT/SPACE#
SITE ADDRESS: 31232 12th Ave SW Federal Way, WA 98023
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL #
CURRENT/PROPOSED USE
$ 9907.20
4168000050 _
PROJECT NAME
(Tenant or Homeowner Last Name)
Pedersen
PV Roof Installation, 3 Circuits, 11.52kW
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
Justin Pedersen
( 253) 736 - 4797
MAILING ADDRESS
E-MAIL
31232 12th Ave SW
justinpedersen628@gmail.com
CITY
STATE
ZIP
FAX
Federal Way
WA
98023
( ) -
NAME
PRIMARY PHONE
Solgen Power, LLC
( 855) 709 -1181
MAILING ADDRESS
E-MAIL
ELECTRICAL
5715 Bedford St
permitting@solgenpower.com
CITY
STATE
ZIP
FAX
CONTRACTOR
Pasco
WA
99301
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
SOLGEPL830RJ 01 / 24 / 2024
604182705
NAME
PRIMARY PHONE
APPLICANT
Solgen Power, LLC
( 855 ) 709 -1181
MAILING ADDRESS
E-MAIL
5715 Bedford St
permitting@solgenpower.com
CITY
STATE
ZIP
FAX
Pasco
�WA
99301
PROJECT CONTACT
NAME
Luz Martinez
PRIMARY PHONE
( 855) 709 - 1181
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: DATE 06/07/2022
PRINT NAME: Luz Martinez
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.corn
Bulletin #160 — April 14, 2016 Page 1 of 1 k:AHandouts\Electrical Permit Application