18-104019City of Federal Wry
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax. (253) 835-2609
Electrical
Permit #:18 -104019 -00 -EL
Inspection Request Line: (253) 835-3050
Project Name: MARTINEZ
Project Address: 30828 20TH AVE S Parcel Number: 053700 0616
Project Description: Upgrade existing panel, replace old outlets and switches.
Owner
Applicant
Contractor
MARINA MARTINEZ
MARINA MARTINEZ
OWNER IS CONTRACTOR
30828 20TH AVE S
30828 20TH AVE S
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional. Permit information
Is this an Online or O.T.C. application? .................. Yes
Alt. Serv./Feeder: 0 to 200 aml
PERMIT EXPIRES Thursday, 29 August, 2019
Permit Issued on Wednesday, August 29, 2018
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
Washington and the City of Federal Way. a
Date:
Owner or agent:
r 15 a
r
THIS CARD IS TO REMAIN ON-SITE 'a
Federal WayTHIS
Inspection Record
INSPECTION REQUESTS: (253) 835-3050
PERAW #: 18104019 00 Address: 30828 20TH AVE S
Project: JEFFREY B MARTINEZ FEDERAL WAY WA 980034919
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.
®
UFER Ground (4295)
®
0
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
Approved
Approved
IBY
Approved
Approved
By
Approved to place concrete
By
Date
By
By
Date
By
Date
®
Pool Bonding (4195)
®
Temporary Power (4275)
®
®
Service (4235)
Approved
Approved
IBY
Approved
Approved
By
Approved
By
Date
By
Date
By
Date
7❑
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date
By
Date
10 Final - Electrical (4055)
Approved
By Date t lL —).X—
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
RECEIVED
AUG 2 9 2018
CITY OF FEDERAL WAY
COMMUNffY DEVELOPMENT
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER
I2_I()(1al9 _��.,
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SITE ADDRESS: 09,14
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S TAR/PARCEL # 0
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
1 /�
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
/Kari uC ev
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PROPERTY OWNER
NAME ' I q
Ma-{ �(iG. �((%{ �_
PRIMARY PHONE
(�I�I'�)3�- o `7
MAILING ADDRESS
308 2g 2 C.
E-MAIL
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CITY
STATE
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FAIT
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ELECTRICAL
CONTRACTOR
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL -
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
-
MAILING ADDRESS _
2- e r
E-
-Z
OTX
ZIP pn
l FAX
PROJECT CONTACT
NAME
/VLOLIy /2 C-_ p� -� -7A
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 flied 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.
SIGNATURE:
PRINT NAME:
c DATE
Bulletin #160 —April 14, 2016 Page 1 of 1 k: HandoutsTlectrical Permit Application
:O rI-7
CITY OF
Federal Way
Property Owner
Electrical Work Permit Application
In Washington, only licensed electrical contractors may perform electrical work. Property owners
may apply for an exemption from these requirements by completing this application and signing
the affidavit below before beginning electrical work.
As authorized under RCW 1.9.28.261, I, /lit d'r l0' - l y6w -/7 � e -Z- hereby apply
(Printed name of property owner, renter, or lessee)
for an exemption from the electrical licensing and certification requirements of RCW 19.28 by
submission of this affidavit.
I statement describes you? (Mark only one. If none apply, you
I own this property.
Your name or your company's name must be shown on the deed to the property. Real estate agents' property
management companies, relatives, etc. cannot purchase permits for the property owner.
❑ I rent or lease this property.
We need a copy of your rental agreement showing you have permission to perform electrical work.
❑ I am an officer for a 501(c)(3) nonprofit corporation, or a nonprofit religious organization.
The total market value of electrical work must be $30, 000 or less and all electrical work must be done by a
non -compensated appropriately certified electrician.
'pe (Mark only one. If none apply you, may not take -out this permil.)
New single family residence that is not intended for rent, sale, or lease, where I will be living for
at least 24 months after completing the electrical work. I will be personally doing the electrical
work.
❑ New 2, 3, or 4 unit residential building, owned by me, that is intended for rent, sale, or lease. I
will be living in one of the units for at least 24 months after completing electrical work. I,
personally, and/or a regularly employed employee(s), will be doing the electricalwork.
❑ New place of business, farm, or other property: Any new structure that is not intended for rent,
sale, or lease. I, personally, and/or a regularly employed employee(s), will be doing the electrical work.
❑ Existing residential property, place of business, or farm. I, personally, and/or a regularly
employed employee(s), will be doing the electrical work.
DEPARTMENT OF COMMUNITY DEVELOPMENT / 33325 8TH AVENUE SOUTH / FEDERAL WAY, WA 98003-6325
253-835-2607 '�& www.cityoffederalway.com 'e& permitcenter(@cityoffederalway.com
Bulletin #080 — June 6, 2018 Page 1 of 2 k:\Handouts\ Property Owner Electrical Work Application
❑ 501(c)(3) or nonprofit religious organization owned property: The total market value of the
electrical work must be $30,000 or less, and all electrical work will be performed by appropriately
certified electricians, or certified and properly supervised trainees, who are volunteering and not
being compensated for the electrical work per RCW 19.28.091(7).
eour signature is required below:
I believe I should be exempt from the requirements to obtain an electrical license, or use a certified
electrician, as provided under RCW 19.28.261.
By signing below, I certify the information I am providing on this affidavit is true and accurate. I /
understand that if I make false statements or misrepresentations, I may be assessed penalties.
Fretted Name of Property Owner, K"ter, or Lessee
ate
W a -r 11'n e --Z— " ltprr / // -,--
Property Owner's Name (Last, First) or Company Name
Mailing Address /Unit/Apt.4 City State Zip
6.
Daytime Phone Email Address
541y -e a S a60✓-! .
DEPARTMENT OF COMMUNITY DEVELOPMENT / 3:,325 8TH AVENUE SOUTH / FEDERAL WAY, WA 98003-6325
253-835-2607 ,swww.cityoffederal%,ay.com -s permitcenter(o)cityoffederalway com
Bulletin #080 — June 6, 2018 Page 2 of 2 k:\Handouts\ Property Owner Electrical Work Application