18-104757f� Y
City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: NGUYEN -PIKE
Project Address: 31313 42ND PL SW
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Electrical
Permit #:18 -104757 -00 -EL
Inspection Request Line: (253) 835-3050
Parcel Number: 873199 0250
Project Description: ADD - Renewal of Permit #12-104893 for the adding/altering (6) circuits for associated kitchen
remodel work
Owner
Applicant
Contractor
VAN NGUYEN
VAN NGUYEN
OWNER IS CONTRACTOR
31313 42ND PL SW
31313 42ND PL SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Additional Permit information
Is this an Online or O.T.C. application? .................. Yes
T 6 EES'
.�....
ResidentialCircuits - '
PERMIT EXPIRES Thursday, 10 October, 2019
Permit Issued on Wednesday, October 10, 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
Wa ington and the City of Federal Way.
Owner or agent: Date: lo // 0 t IS -0 1;�'
a - &- THIS CARD IS TO REMAIN ON-SITE •
Federal Way Construction Inspection Record
y INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 18104757 00 Address: 31313 42ND PL SW
Project: ADAM N PIIS FEDERAL WAY WA 98023-2118
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE T IS 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.
0 Final - Electrical (4055)
Approved
By Date
Rough Electrical
Final Electrical
❑
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
CITY OF S =9
Federal Way
PERMIT 9:
IS c.ARD IS TO REMAIN ON-SITE
Construction Inspection Record'
INSPECTION REQUESTS: (253) 835-3050
12 -104893 -00 -EL Address: 31313 42ND PL SW
Project: VAN NGUYEN FEDERAL WAY, WA 98023-2118
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.
Final - Electrical (4055)
Approved
By Date
EJ
UFER Ground (4295)
Ditch cover (4030)
Final Electrical
Approved,
Slab/Concrete Floor (4255)
EJ
Approved
By
Approved
[BY
Approved to place concrete
By
Date
By
Date
By
Date
Final - Electrical (4055)
Approved
By Date
EJ
Pool Bonding (4195)
E] Temporary Power (4275)
Final Electrical
Approved,
Service (4235)
EJ
Approved
By
Approved
Approved
By
Date
By
By Date
By
Date
Feeders/Sub-panels (4045)
E] Rough Electrical (4225)
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
ByA_��? Date `0-2g-1
By
Date
Final - Electrical (4055)
Approved
By Date
EJ
Rough Electrical
Approved
Final Electrical
Approved,
EJ
Right of Way —�
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
RECEIVED
OCT A 0 2018
ELECTRICAL
PERMIT APPLICATION
orCITY OF FEDERAL WAY
muN(1Y DEVELOPMENT
PERMIT NUMBER 1 t -7 55-7
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SITE ADDRESS: 31
S 1 '0 D -, -FDFKr' L VA
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SUITE/UNIT/SPACE #
PROJECT VALUATION
00,Q0
ASSESSOR'S TAR/PARCEL #
'�r -7 3 L �_ - .0
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
V
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
NAME
i1A )
PRIMARY PHONE
(24 ) fp - A-
MAILINrZ ADDRr--
E-MAIL
C�pr+f,+/w r
CITY
r
STATE
VVI
ZIP�
�Do2
FAX
( ) -
ELECTRICAL
CONTRACTOR
NAME
WN
PRIMARY PHONE
( ) -
MAILING ADDRESS
0 VV Nf,
E-MAIL
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME
PRIMARY PHONE
( )
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
( )
PROJECT CONTACT
NAME
E
PRIMARY PHONE
( ) -
I certify under penalty of perfury 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 par�f this application.
SIGNATURE:
PRINT NAME:
Bulletin # 160 —April 14, 2016 Page 1 of I k:\Handouts\Electrical Permit Application
CITY OF
Property Owner
Federal Way Electrical Work Permit Application
13- 1 Oq 757
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 19.28.261, I, V AN� N 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 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.
❑ 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.
N' 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 -eswww.cityoflederalway.com -s permitcenter@cityoffederalway.com
Bulletin #080 — June 6, 2018 Page I of 2 k:\Handouts\ Property Owner Electrical Work Application