19-102345 4 _
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Electrical
City of Federal Way Permit #:19-102345-00-EL
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: ANN'S NAILS
Project Address: 32901 1ST AVE S Parcel Number: 697900 0030
Project Description: Installing a new outlet,lighting for reception desk,and wiring a hot water tank.
Owner Applicant Contractor
FLOOR COVERING PF RESILIENTFIoor ANN HOANG TENANT IS CONTRACTOR
Covering Pf 35808 57TH AVE S
12886 INTERURBAN AVE S AUBURN WA 98001
SEATTLE WA
98168-3318
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Additional Permit Information
Is this an Online or O.T.C.application? Yes
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Circuits-Commercial 4
PERMIT EXPIRES Wednesday, 13 May,2020
Permit Issued on Tuesday,May 14,2019
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
Washington and the City of Federal Way.
Owner or agent: Z 2 4Vl t Date: ,C7/1///
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40A0 THIS CARD IS TO REMAIN ON-SITE
Federal Wa Construction Inspection Record
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 102345 00 Address: 32901 1ST AVE S Unit I
Project: Floor Covering Pf Resilient FEDERAL WAY WA 98003
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.
0 Ditch cover(4030) 0 Service(4235) 0 ' Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
0 Rough Electrical(4225) El Ceiling Cover(4020) ® Final-Electrical(4055)
pproved Approved Approved
By l I Date *3" 3 -17 By Date By Date
El Rough Electrical ❑ Final ElectricalElRight of Way
Approved Approved Approved
By Date By Date By Date
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Federal WayMAY 14 2019 PERMIT APPLICATION
CITY FEDERAL WAY / q _ / 0 3 Lr c--._ /
CGMMUFJCN TY DEVELOPMENT PERMIT NUMBER — —
SUITE/UNIT/SPACE
SITE ADDRESS'
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 2-en -
PROJECT NAME
(Tenant or Homeowner Last Name) v nl
oWI St o_
PROJECT DESCRIPTION (IdCI ori p i * i' n t Lto K
Detailed .f work to o description p
be included on this permit only , k Dv, ' dee„r `Dyi
NAME
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i .l PRIMARY PHONE
PROPERTY OWNER 'T-PA rI t ar Jrq -f r 1 eol in no ('2J S-7 se Ok3
MAILING ADDRESS E-MAIL /
331 3 1 W ,s b�^; I i-eYPCbalg71
C STATE ZIP FAX
/
N E PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME A PRIMARY PHONE
APPLICANT MAILIN ADDRESSE-MAIL
3..2-9 ot isfi /4ve C --
CITY STATE ZIP FAX
E PRIMARY PHONE
PROJECT CONTACT ( )
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 o such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim es out o the reliance of the city, including its officers and employees, upon the accuracy of the
information supplie• ,• as a p f this application.
SIGNATURE:
igil
DATE 5I I y\ I
PRINT NAME:
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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RECEIVED
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MAY 1 li 2019 - .
CITY OF ' '' -‘ -=_„a: Property Owner
Federal Way comMUNFY DEvaagtrical Work Permit Application
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- Applying For`Your-Electrical.:Pe it •
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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.
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_ Affidavit - ;y. :r0
As authorized under RCW 19.28.261, I, -1)111,VIL }k()aryl hereby Ppa 1
Y/
(Printed name of property owner, enter,or lessee)
for an exemption from the electrical licensing and certification requirements of RCW 19.28 by e
submission of this affidavit.
Which statement describes you? (Mark only one. If none apply,you may not lake out this permit.) .
I 0 I own this property. I
€ Your name or your company's name must be shown on the deed to the property. Real estate agents'property
1 management companies, relatives, etc. cannot purchase permits for the property owner. E
1 I rent or lease this property.
We need a copy of your rental agreement showing you have permission to perform electrical work.
0 I am an officer for a 501(c)(3)nonprofit corporation,or a nonprofit religious organization.
1 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. I
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Select your property type (Mark only one.If none apply,you may not take out this permit) - 1
1 0 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
I work.
❑ New 2,3,or 4 unit residential building,owned by me,that is intended for rent, sale, or lease. I i
F will be living in one of the units for at least 24 months after completing electrical work. I, i
4 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, t
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. i
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 is www.cityofiederalway.com Is permitcentere,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).
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
understand that if I make false statements or misrepresentations, I may b assessed penalties.
Ashy
Printed Name of Property Own*,Renter,or Lessee Signature
Date
• -- opera Ownerand-hnspection-Site:I•nf rr n►-atroi
Property Owner's Name(Last,First)or Company Name
_4-rt€cI m ik-en ry -}cd- rcdceoud top Rgao3
Mailing Address Unit/Apt.# City State Zip
2 -4S7V ?200 h1;f l e CIJclay7For-Vh . con)
Daytime Phone Email Address
Inspection Site Address(if different) Unit/Apt.# City Stat• Zip
County 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
253-835-2607 www.cityoffederalway corn zs.permitcenterAcitvoffederalway.com
Bulletin#080—June 6,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Application