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19-103884 Electrical City of Federal Way Permit #:19-103884-00-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: SHAFER Project Address: 36933 6TH AVE SW Parcel Number:218820 2350 Project Description: Panel change Owner Applicant Contractor JOHN H SHAFER JOHN H SHAFER OWNER IS CONTRACTOR 36933 6TH AVE SW 36933 6TH AVE SW FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 Additional Permit Information Is this an Online or O.T.C.application" Yes -A 7;y3;' -, ,3 s" .,, «"ir x,>r�a'i,u''.i�. `" '«! _�s;=r ah; n- rc_ti� :ii'.+ "` • r-i :lY'r ,gyp :..a.: „YG't ;;:s,' :"•: j yyt '�.�•': =��, �f�,,, ;,•�. iy W .. "t% 11:14:,%:*;:*?:a»�,.'•rw ant.�,� z�`.`;�:..."�',n..''' ,^,ys�, ."•"b. .0„V 4^ _ . l. .+a,3K ' s�•.� .,.. �+x�• � ': uvrP` �..", s , Alt.Serv. Feeder:0 to 200 ami 1 PERMIT EXPIRES Tuesday, 11 August,2020 Permit Issued on Monday,August 12,2019 I hereby certify that he above information is correct and that the construction on the above described property and the occupa y and the use will be in accordance with the laws, rules and regulations of the State of ashington and the City of Federal Way. Owner or agent: Date: `b/1.1-/ 19 i/ 4 in:;11 , THIS CARD IS TO REMAIN ON-SITE 4. •,, : Fecleral v1/ay Construction Inspection Record INSPECTION REQUESTS:(253)835-3050 PERMIT#: 19 103884 00 Address: 36933 6TH AVE SW Project: JOHN H SHAFER FEDERAL WAY WA 98023-7273 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) Q Ditch cover(4030) El Slab/Concrete Floor(4255) Approved Approved Approved to place concrete By Date By Date By Date Q Pool Bonding(4195) Q Temporary Power(4275) ® Service(4235) Approved Approved Approved By Date By Date By Date Q Feeders/Sub-panels(4045) ® Rough Electrical(4225) 9❑ Ceiling Cover(4020) Approved Approved Approved By • Date By Date By Date ID Final-Electrical(4055) 3- 0 v By Date �� • 0 Rough Electrical 0 Final Electrical ❑ Right of Way Approved Approved Approved By Date By Date By Date RECEIVED AUG 12 2019 ELECTRICAL F Y OF ciTy pF FEDERAL WAY PERMIT APPLICATION Federal Way QoMMUN(TY DEVELOPMENT PERMIT NUMBER l _ ' 3 8 I _ L SUITE/UNIT/SPACE SITE ADDRESS: 3 c3, � 3 ALJ►'�/L 3 /�w �Q C" PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE $ tOOc'? , S 2 C� _ 2 3 5-0 PROJECT NAME (Tenant or Homeowner Last Name) PROJECT DESCRIPTION S V (Cr_ L-14 1,141 , Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER Zd L S I1acw (2S3 )37C -Qrg MAILING ADDRESS E-IWL 36`-33 t UC; ��- s � G Y ,1( , CITY,, STATE ZIP FAX d 2�,( \Arpvy �^'� 110 Z: ( ) NAMEPRIMARY PHONE 11,0144.e, ) - MAILING ADDRESS E-MAIL ELECTRICAL CONTRACTOR CITY STATE ZIP FAX ( ) WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# NAME PRIMARYPRPHONE APPLICANT - ‘e)t141 � 223 )3`4. -ot9%'(" SLING ADDRESS E-MAIL 33 CITY STATE ZIP FAX iA�� -r,,,y wit-- C73 ( ) - NAME 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 ense of such claim), which may be made by any person,including the undersigned,and filed against the city, but only where such im arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied the city as a p of this application. �J SIGNATURE: DATE cU! I Z_ / A PRINT NAME: �L S ��4✓ Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application CITY OF .�a►....i RECEIVED Property Owner Federal Way AUG 11 2019 Electrical Work Permit Affidavit CITY OF FEDERAL WAY COMMUNITY DEVELOPMENT In Washington, only licensed electrical contractors may perform electrical work. Property owners may apply for an exemption from these requirements by completing and signing the affidavit below before applying for an electrical permit or beginning electrical work. . . a� . , As authorized under RCW 19.28.261, I, b1, a� f e_ W (Printed name of property 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. I,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 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325 253-835-2607 z9.www.cityoffederalway.com permitcenter(a)citvoffederalway.com Bulletin#170—July 27,2018 Page 1 of 2 k:\Handouts\Property Owner Electrical Work Affidavit ❑ 501(c)(3) or nonprofit religious organization owned property:The total market value of the • 1 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 hat if I make fa e statements or misrepresentations, I may be assessed penalties. i tV 17.1 ICI Signature Date . J0141. SEn. G"Cw I Printed Name of Property Owner,Renter,or Lessee Li . ...,.. --., ,..s. _ .r,.....im...,,a.. Property Owner and inspection Site Information 1 t-tot-f- IProperty Owner's Name or Company Name 1 C 911 CL- 1 •C''' Cede.-"1 ,.y \A/11-, qo�3 Mailing Address Unit/Apt.# City State Zip 30i1, (40\P4-6 1/41,4:1 , cv Iv\ Daytime Phone EmailAddress h , ° Inspection Site Address Unit/Apt.# ;3 d pct_ Electrical Power Company/Serving Utility Description of work being done (Example: adding outlets in the kitchen,second floor break area,etc.) � *! ('Cc Chap 9t i I DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325 253-835-2607 2%.www.citvoffederalway.com zs.permitcenter@citvoffederalway.com Bulletin#170—July 27,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Affidavit