19-103971 Electrical
City of Federal Way Permit #:19-103971-00-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: BARAJAS
Project Address: 31625 13TH AVE SW Parcel Number:416795 0250
Project Description: Add(1) 15A GFCI-Ark combination for bedroom.Add(1)15A-Ark fault combination for
smoke/carbon detectors.(1)20A 240 for bedroom heat.
Owner Applicant Contractor
MARIA BARAJAS CARLOS BARAJAS OWNER IS CONTRACTOR
31625 13TH AVE SW 31625 13TH AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
Ct-4:P:Tti E ', 'E. k E .nt. cisr ..
PERMIT EXPIRES Saturday,15 August,2020
Permit Issued on Friday,August 16,2019
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 arid regulations of the State of
Wshington and the City of Federal Way. 8
Owner or agent: 1JI�l Date: 16
1../
.,.'' A'' THIS CARD IS TO REMAIN ON-SITE ' ' _.
`""OF Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253)835-3050
PERMIT#: 19 103971 00 Address: 31625 13TH AVE SW
Project: CARLOS BARAJAS FEDERAL WAY WA 98023-4722
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.
,EI UFER Ground(4295) .,0 Ditch cover(4030)
.4 .
Slab/Concrete Floor(4255) ,
Approved Approved Approved to place concrete
.By Date •.,By Date By Date
0 Pool Bonding(4195) ; El Temporary Power
p ry (4275
) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
'
El Feeders/Sub-panels(4045) • El Rough Electrical(4225) El Ceiling Cover(4020)
Approved Approved QApproved
By Date By ,e, Date /0 ""-/ ; By Date
•
El Final-Electrical(4055)
Approved
By17, Date/74;Z'/9
•
0 Rough Electrical ❑ Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date
r RECEIVED ELECTRICAL
CITY OF
Federal Way AUG 16 2019 PERMIT APPLICATION
UN o��� ? 9 _ / 0 3 '( -11 _ e- L_
UMBER
2G..- 1124-
' N - S•� SUITE/UNIT/SPACE#
SITE ADDRESS: 3 %
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
PROJECT NAME C1�✓!�� �, Co IN•1`I S 1 O n
(Tenant or Homeowner Last Name)
I ( iS`(km? C-1'V CI - A,/v_ CO,..0.„)1 b; no.4•io n
PROJECT DESCRIPTION ViGd✓oor . •
1.
Detailed description of work to 1 ( I caM c-,-,:c.. 1 e -14i,4 �'�v (,py�,�p :^......k.I 0,.-.be included on this permit only r
?ri.o A cy I cov.- b an. d`t.'r I._.A.,..", s t
9 LaocA...? a--to 1 .c,,, rao c..-i-
NAME PRIMARY PHONE
PROPERTY OWNER C.),,,,‘p 5 Y t VD Gv GA • 4 3 )9S(S"- 51,04
MAILING ADDRESS E-MAIL
'31(07-c I174" Pku-e- S• ' C i osgb 1210o k0. .:, )
CITY STATE ZIP FAX
T:Ce1
NAME
_..__. PRIMARY PHONE
0t4Y►l/� ( )
MAILING ADDRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME af PRIMARY PHONE
APPLICANT O ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT O1/4,-' 4 ( ) _
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.C
SIGNATURE: 'I05 All08 DATE 7/3o/i /
PRINT NAME: CA 40-$ 1) . 6 R 1roda-5
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
RECEIVED 19 1 °: 9s-1 I - 00- ti- (--
'NILAUG 16 2019
CITY OF ... ..., Property Owner
Federal WayCITY OF FEDERAL WAY
CITY OF
Work Permit Affidavit
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In Washington, only licensed electrical contractors may perform electrical work. Property owners
Imay apply for an exemption from these requirements by completing and signing the affidavit
below before applying for an electrical permit or beginning electrical work.
'40
,,
Affidavit \ i
authorizedg As under RCW 19.28.261, 1, ✓t os it l I1r S
(Printed name of property owner,rente r lessee)
hereby apply for an exemption from the electrical licensing and certification requirements of r
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)
ii 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.
i
Select your property type'(Mark only one. If none apply,you may not lake out this permit.)
11New 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.
1
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 zi www.citvoffederalway.com permitcenter(c.citvoffederalway.com
Bulletin#170—July 27,2018 Page 1 of 2 k:\Handouts\Property Owner Electrical Work Affidavit
0 501(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
i 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.
1 By signing below,I certify the information I am providing on this affidavit is true and accurate. I
t understand that if I make false statements or misrepresentations, I may be assessed penalties.
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1 Signature at
d?/4".1 ,2. r�Ar- ai
Printed Name of Property Owner,Rente r Lessee
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Property Owner's Name and/or Compaq Name _
31102 13 4-1,1.j So,) i'e(Je4/U 1 u)uy tkyk 4• 1 °.-13
Mailing Address Unit/Apt.# City / State Zip
1, 3 , Cr6 S - CYO y Ce,r los aka I/l0(---- h04014', ) . LM
Daytime Phone Email Address
31b.2_<" 13 ` c-P SL :
pectionite Address Unit/Apt.#
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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.citvoffederalway.com z9 permitcentere.citvoffederalway.com
Bulletin#170—July 27,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Affidavit