19-101230r- 4
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: MARTINEZ
Project Address: 623 S 304TH ST
Project Description: Replace meter base.
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Electrical
-� Permit #:19 -101230 -00 -EL
' Inspection Request Line: (253) 835-3050
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Parcel Number: 232950 0120
Owner
Applicant
Contractor
JULIAN MARTINEZ
JULIAN MARTINEZ
OWNER IS CONTRACTOR
623 S 304TH ST
623 S 304TH ST
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
Additional Permit Information
Is this an Online or O.T.C. application? .................. Yes
Mast or Meter Repair (Resider 1
PERMIT EXPIRES Tuesday, 17 March, 2020
Permit Issued on Monday, March 18, 2019
I hereby certify that the above information is correct and that the construction on the above described property
and the occupancy and th 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: —
Z2
THIS CARD IS TO REMAIN ON-SITE
`r"�` Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 19101230 00 Address: 623 S 304TH ST
Project: JULIAN S MARTINEZ FEDERAL WAY WA 98003-4018
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.
El
UFER Ground (4295)
El
Ditch cover (4030)
®
Slab/Concrete Floor (4255)
By
Approved
IBY
Approved
By
Approved to place concrete
By
Date
Date
By
Date
®
Pool Bonding (4195)
Approved
®
Temporary Power (4275)
Approved
®
Service (4235) /Ic-4/
Approved SSC
JK7�
By
Date
By
Date
By
Date ^ -
Approved
Approved
By
Date
0
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
Approved
IBY
Approved
Approved
By
Date
Date
By
Date
®
Final - Electrical (4055)
Approved
By
Date
Rough Electrical
Final Electrical
E]
Right of Way
Approved
Approved
Approved
By
Date
By
Date
By
Date
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CITY OF
Federal Way
MAR 18 2019
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
ELEC'T'RICAL
PERMIT APPLICATION
PERMIT NUMBER J - _10—
/D / 2 L _ J
SITE ADDRESS: 2- -; S, :I&A S,�_
SUITE/UNIT/ SPACE #
PROJECT VALUATION
OCA
ASSESSOR'S TAX/PARCEL #
-
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PROPERTY OWNER
NAME IF
i .
PRIMARY PHONE
q - 6� 312
MAILING ADDRESS
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E-MAIL
CITY
e de
STATE
ZIP
O
FAX
( )
ELECTRICAL
CONTRACTOR
NAME
�C? MQL,/4 ne
(/ PRIMARY PHONE
l )
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
E-MAIL
CITY
STATE
I ZIP
FAX
( )
PROJECT CONTACT
NAME
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 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 tbo.,city as a part of this application.
SIGNATURE:
PRINT NAME:
Bulletin #160 —April 14, 2016 Page 1 of 1 kMandouts0ectrical Permit Application
Y
A
CITY OF
Federal Way
RECEIVED
Property Owner
MAR 8 2019 Electrical Work Permit Affidavit
CITY OF FEDERAL WAY
CWMUNFTY DEVELOPMENT
A, MO fit
As authorized under RC W 19.28.261, I, /-1(
(Printed name of prope y owner, renter, or lessee)
hereby apply for an exemption from the electrical licensing and certification requirements of
RCW 19.28 by submission of this affidavit.
Which statement describes you? (Mark only one. If none apply, you may not take out this permit.)
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.
Select your property type (Mark only one. If none apply, you may not take out this permit.)
❑ 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. 1, personally, and/or a
regularly employed employee(s), will be doing the electrical work.
❑ 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 8T" AVENUE SOUTH / FEDERAL WAY, WA 98003-6325
253-835-2607,Nwww.citvoffederalwaV.com zs. permitcenter(d-)cityoffederalway.com
Bulletin #170 — July 27, 2018 Page 1 of 2 k:\Handouts\ Property Owner Electrical Work Affidavit
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❑ 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).
Your 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
under77t if I make false statements or misrepresentations, I may be assessed penalties.
Signtre
Date
rinted Name �ofProp�ertv Owner, Renter, or Lessee
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Property Owner and Inspecd
R/J-
i'Site Information
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Property Owner's Name or Company Name
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Mailing Address Unit/Apt.# City State Zip
D ytime Phone Email Address v C
i
Inspection Site Address Unit/Apt.#
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Electrical Power Company / Serving Utility
Description of work being done (Example: adding outlets in the kitchen, second floor break area, etc.)
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DEPARTMENT OF COMMUNITY DEVELOPMENT / 33325 8TH AVENUE SOUTH / FEDERAL WAY, WA 98003-6325
253-835-2607i& www.citvoffederalway.com zs Permitcenter(a)cityoffederalway.com
Bulletin #170 — July 27, 2018 Page 2 of 2 k:\Handouts\ Property Owner Electrical Work Affidavit
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