19-101074 •
Electrical
City of Federal Way Permit #:19-101074-00-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: 4306 SW 333RD ST ' Parcel Number: 142103 9048
Project Description: Electrical to include complete rewire of existing home.
Owner Applicant Contractor
S BLUE SKY LLC S BLUE SKY LLC OWNER IS CONTRACTOR
4306 SW 333RD ST 4306 SW 333RD ST
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
USA USA
Additional Permit Information
Is this an Online or O.T.C.application" Yes
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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
Washington and the City of Federal Way.
Owner or agent: Date: 03/0 712014
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,, ill& THIS CARD IS TO REMAIN ON-SITE •►
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Construction Inspection Record
INSPECTION REQUESTS:(253)835-3050
PERNIIT#: 19 101074 00 Address: 4306 SW 333RD ST
Project: S BLUE SKY LLC FEDERAL WAY WA 98023-3205
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) ID Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 0 Temporary Power(4275) ® Service(4235)
Approved Approved Approved
By Date By Date By / A Date ( 4...,
Feeders/Sub-panels(4045) ® Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved i Approved / 9 Approved
By Date By Date --G ~I / By Date 5-3o 1
® Final-Electrical(4055) V
Approved
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By Date rar.1)
Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date •
23391,
�� RECEIVED ELECTRICAL
CITY OF �� MAR 0 7 2010
Federal Way PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER I _ b _ `7
SUITE/UNIT/SPACE#
SITE ADDRESS:
4301 S 333rd SIL 44e-e./ /1K0 9Ia.L3
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ 6.00.,. (( (-1z_ 103 _
PROJECT NAME
(Tenant or Homeowner Last Name) 4-,3.�j 441./el
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fewwJe 44 iL �/e � (e ✓: ,t 1
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME n / PRIMARY PHONE
PROPERTY OWNER S lie Shy /Ce (,Za t ) 771!
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
ieelanAe 144 gee' 7 ( ) -
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
1ve y // (24 ) 788 - 77/1
APPLICANT MAILING ADDRESS
E-MAIL
CITY �j STATE ZIP FAX
fl`eiet W4 Qg 7 ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT 7ovy ) 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: C Y � DATE v 3/T/2 /
PRINT NAME: a^yn �L
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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Property Owner
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Federal Way Electrical Work Permit Application
- Applying For.Your Etecti-ical Painit
In Washington, only licensed electrical contractors may perform electrical work. Property owners I
: may apply for an exemption from these requirements by completing this application and signing
the affidavit below before beginning electrical work.
Affidavit,: ,t,�.r .i
i As authorized under RCW 19.28.261, 1, filar SAy 116 hereby applyr
(Printed name of property owner,renter,or lessee)
for an exemption from the electrical licensing and certification requirements of RCW 19.28 by
submission of this affidavit.
il Which statement describes you? (Mark only one.If none apply,you may not take out this permit.)
la I own this property.
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.
❑ 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.
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I
a Select your property type(Mark only one.If none apply,you may not take out this permit.) t
I Ii1 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
work. i
k
❑ 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(s),will be doing the electrical work.
5
❑ 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 N.www.citvoffederalway.com permitcentert citvoffederalway.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 be assessed penalties.
S
PIA/ `y /l6
Printed Name of Property Owner,Renter,or Lessee Signature
o3/o7/2 ,q
Date
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Property Owner and Inspection Site Infor nation : : >,x
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Property Owner's Name(Last,First)or Company Name
/1040 8>s2 ST STF -24 /3d�evue w
Mailing Address Unit/Apt.# City State Zip
A>6- 781 S29K -AN,/.)v Q A=F,�./. 1.,,�.
Daytime Phone � Email Address
33 3°3 /3rd 4,4W) r edL✓/ .^'ail W4 ?kV-3
Inspection Site Address(if different) Unit/Apt.# City State Zip
County Electrical Power Company/Serving Utility
Description of work being done(Example:adding outlets in the kitchen,second floor break area,etc.)
w,we 4e talth
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 z9 www.cityoffederalway corn permitcenter@cityoffederalway.com
Bulletin#080—June 6,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Application