19-101152City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax (253)835-2609
Project Name: SMALL
Project Address: 31528 42ND AVE SW
A
Electrical
Permit #:19 -101152 -00 -EL
Inspection Request Line: (253) 835-3050
Project Description: Electrical work to include running a new circuit in the garage.
Parcel Number: 873198 2800
Owner
Applicant
Contractor
GREGORY J SMALL
GREGORY J SMALL
OWNER IS CONTRACTOR
31528 42ND AVE SW
31528 42ND AVE SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Is this an Online or O.T.C. application?
Circuits - Residential
Additional Permit Information
Yes
PERMIT EXPIRES Wednesday, 11 March, 2020
Permit Issued on Tuesday, March 12, 2019
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
Was ' gton and the City of Federal Way.
Owner or agent: Date:
C
THIS CARD IS TO REMAIN ON-SITE ..
cr"OFa� 1IVa Constfuction Inspection Record
FederWay INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 19101152 00 Address: 31528 42ND AVE SW
Project: GREGORY J SMALL FEDERAL WAY WA 98023-2120
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
0
Ditch cover (4030)
3
Slab/Concrete Floor (4255)
Approved
]BY
Approved
Approved
IBY
Approved
By
Approved to place concrete
By
Date
By
By
Date
By
Date
®
Pool Bonding (4195)
0
Temporary Power (4275)
®
Service (4235)
Approved
]BY
Approved
IBY
Approved
By
Date
By
Date
By
Date
El
Feeders/Sub-panels (4045)
®
Rough Electrical (4225)
®
Ceiling Cover (4020)
Approved
Approved
Approved
By
Date
By
Date 3 A, q
By
Date
Final - Electrical (4055)
%pproved /�j�
By` Date �f�
Rough Electrical
Final Electrical
Right of Way
Approved
Approved
IBY
Approved
By
Date
I By
Date
Date
Of O
cr F
Federal Way
RECEIVED ELEC'T'RICAL
MAR 12 2019 PERMIT APPLICATION
CITY OF COM UNITY D FEDERAL WAY _ I O 1 I c Z_
"BER c J
SITE ADDRESS: �) �- �p ZN P V& =Std
d
SUITE/UNIT/SPACE #
PROJECT VALUATION
ASSESSOR'S TAX/PARCEL # \)
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
PROJECT DESCRIPTION
1�/�� r �� C 1)LC " ! /�2 ✓ G
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
cn- X22 C
( Z 5 3) SO Y - 13 576
MAILING ADDRESS
E-MAIL
CITY
STATE`
ZIP
FAX
NAME -
PRIMARY PHONE
O
MAILING ADDRESS
E-MAIL
ELECTRICAL
CITY
STATE
ZIP
FAX
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
w 2
)
MAILING ADDRESS
E-MAIL
CITY
STATE
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 maybe made by any person, including the undersigned, and filed against the city,
but only where such claim arises out oft reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part r his application.
SIGNATURE:DATE
PRINT NAME:
Bulletin # 160 — April 14, 2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
CITY OF
Federal Way
RECEIVED
MAR 12 2019
cPggtFjR AWork
COMMUNfTY DEVELOPMENT
Property Owner
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 19.28.261, 1, L, 2��aG I& td —1 Z t / hereby apply
(Printed name of pr perty 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 thisproperty.
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 ); be doing the electrical work.
Existing residential property, place of business, or farn( I, personally, nd/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 -,s, www.citvoflederalway.com -6L permitcenter(cDcitvoffederalway.com
Bulletin #080 - June 6, 2018 Page 1 of 2 k:\Handouts\ Property Owner Electrical Work Application
a
❑ 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).
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`
rrmtea name or rropetty towner, xenter, or
i
lz
Date