19-101075 4'✓" Y
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Electrical
City of Federal Way Permit #:19-101075-00-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: S BLUE SKY LLC
Project Address: 33303 43RD AVE SW Parcel Number: 142103 9047
Project Description: Electrical to include complete rewire of existing home.
Owner Applicant Contractor
S BLUE SKY LLC S BLUE SKY LLC OWNER IS CONTRACTOR
33303 43RD AVE SW 33303 43RD AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
USA USA
Additional Permit Information
Is this an Online or O.T.C.application') Yes
`$ FixtiirlosA ted With This Permit!!.
PERMIT EXPIRES Friday,6 March,2020
Permit Issued on Thursday,March 7,2019
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
Wash' gton and the City of Federal Way.
Owner or agent: Date: J3k4 cl
r ripti
4 r
THIS CARD IS TO REMAIN ON-SITE
CITYOP Construction Inspection Record
vp7 INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 101075 00 Address: 33303 43RD AVE SW
Project: S BLUE SKY LLC FEDERAL WAY WA 98023-3202
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 LIFER Ground(4295) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By / 2° Date 3—I
0 Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved ApprovedApproved
By Date By , " Date5 5 / By // , Date ....
--S" l !
1:1 Final-Electrical(4055)
By eed
/(PDleY;aki
•
0 Rough Electrical 0 Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OF
RECEIVED ELECTRICAL
Federal Way MAR 0 7 2019 PERMIT APPLICATION
CITY OF FEDERALWAY
COMMUNITY DEVELOPT NUMBER ' G/ _ 0
� 0 7 _ -CZ -
_I 'I, SUITE/UNIT/SPACE#
SITE ADDRESS: 333,„3 13rd 45/Ce W 44,1 Ay, W4 71.1 5
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# / CURRENT/PROPOSED USE
�a . y Z 1 v 3 _
PROJECT NAME j /
(Tenant or Homeowner Last Name) ,J33''17
Hiee Mel
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAMEJJ PRIMARY PHONE
PROPERTY OWNER gee 4' /�C ( C ) 711- 771/
MAILING ADDRESS E-MAIL
4.41. /tit A sr 5Th)'›ie
CITYSTATE ZIP FAX
l�e�e e IA �111�,� ( )
.._— . .—_. NAME PRIMARY PHONE
) -
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
_
NAME PRIMARY PHONE
/� e
APPLICANT -"k ' ()6 4Y) � - -7 711
MAILING ADDRESS l C Sir
a E-MAIL
/ Y� S� 11 2,8
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CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT 7�, Iv (-z ) 782 - 771/
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 the city as a part of this application.
SIGNATURE: DATE 423 42 7/2am/y
PRINT NAME:
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
'CITY OF -.-, Property Owner
p Y
Federal Way Electrical Work Permit Application
Applying For'Yotir Electrical Perlllnit . ,.
In Washington, only licensed electrical contractors may perform electrical work. Property owners
smay apply for an exemption from these requirements by completing this application and signing F
the affidavit below before beginning electrical work.
As authorized under RCW 19.28.261, I, $ ale 4 //( hereby apply
(Printed name of property owner,renter,or lessee) ,
for an exemption from the electrical licensing and certification requirements ofRCW 19.28 by 1 -
submission of this affidavit.
k
Which statement describesyou?( Mark only one.if none apply,you may not take out this permit.) c
In 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
c management companies, relatives, etc. cannot purchase permits for the property owner.
W
❑ I rent or lease this property. a'
tWe 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.
F 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. r
Select your property type(Mark only one. If none apply,you may not take out this permit.) ).
if
t ll New single family residence that is not intended for rent, sale,or lease,where I will be living for i
at least 24 months after completing the electrical work. I will be personally doing the electrical 1
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, L
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. i
i ❑ 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 zs www.cityofiederalway.com permitcentert 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 i
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. r'
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.
Blue
Printed Name of Property Owner,Renter,or Lessee Signature
a3/0/1-'iq
Date
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Property Owner:and Inspection Site Information
aP
Property Owner's Name(Last,First)or Company Name
/140tiv gtz st .0E-zog Bdlie„ue 9,e0 7
Mailing Address Unit/Apt.# City State Zip
06- 7gX--sz .10r71 A-t, : tow.
Daytime Phone Email Address
4-3.4 .Su) 333rd Sf 4ed-u/ Way w,� gse-z3
Inspection Site Address(if different) Unit/Apt.# City State Zip
1.
Count Electrical Power Company/Serving Utility
Description of work being done(Example:adding outlets in the kitchen,second floor break area,etc.)
Rew:✓e fl+e W Je Hawse
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 is www.cityoffederalway.com permitcenter(a�cityoffederalway.com
Bulletin#080-June 6,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Application