19-103954 Electrical
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City of Federal Way Permit #:19-103954-00-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: UNO
Project Address: 30620 2ND AVE SW Parcel Number: 556000 0760
Project Description: Move dryer hookup;add 2 outlets
Owner Applicant Contractor
GORDY UNO GORDY UNO OWNER IS CONTRACTOR
30620 2ND AVE SW 30620 2ND 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
Circuits-Residential 2
PERMIT EXPIRES Friday, 14 August,2020
Permit Issued on Thursday,August 15,2019
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: W Date:T-' � (5,
—
THIS CARD IS TO REMAIN ON-SITE
Federal Way Construction Inspection Record
Fed
y INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 103954 00 Address: 30620 2ND AVE SW
Project: GORDY UNO FEDERAL WAY WA 98023-3906
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.
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® UFER Ground(4295) , ® Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) ® Temporary Power(4275) 0 Service(4235)
Approvedi Approved Approved
By Date By Date By Date
® Feeders/Sub-panels(4045) ® Rough Electrical(4225) 1 ® Ceiling Cover(4020)
Approved Approved Approved
.By Date �;�By ��`" Date /C 2 /O'/9 .;By Date
ID Final-Electrical(4055)
Approved
By /.1 Date /Zip '?
0 Rough Electrical 0 Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
IA RECEIVED ELECTRICAL
CITY OF
Federal Way AUG5 2019PERMIT APPLICATION
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT 3
PERMIT NUMBER i / _ / 0 q y _ t
SUITE/UNIT/SPACE#
SITE ADDRESS: 30 4o20 2t,c) Aum s, (-%-)
w r
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
$ `1Ua 45 cS (`o eD 0 0 _ 0 ---77 & 0
PROJECT NAME
(Tenant or Homeowner Last Name) G o e)� U v%_
P#k-05 v e_ tis- cue:I t-,-- cJ
PROJECT DESCRIPTION a c) 1to.4-s
Detailed description of work to
be included on this permit only
NAMEII PRIMARY PHONE
PROPERTY OWNER GO��� U v• O (206.)72C2- 41o26MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
ekre( Ww'
it CrZ02-3 ( ) -
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
��te� U G (Zf 743- f�zs 26
APPLICANT MAILING ADDRESS gd��v E-MAIL
36C,, 2O 9•1.04-C. nuc GO - QG�ai [ .C-61AN;
CITY STATE ZIP FAX
rtJ p,"4( Wu, c.j , gF623 ( ) -
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 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: .n./ DATE " / S—` / 9
PRINT NAME: GU u- .---(
j U ti
Bulletin#160–April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
RECEIVED 1 9 - I ° 0
3�15�f 0 L
�fTYaF : AUG 15 2019 Property Owner
��,�r p Y
Federal CITY OF FEDEI tIpy
CpMMUNfIYDEYE wytrical Work Permit Application
Applying For Your Electr cal Permit
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. _
4 .Af'fdavit r _;�I I
eF Z
tisri
As authorized under RCW 19.28.261, I, Govr�t, Uv\..a hereby apply
(Printed name of property owner,renter,or lessee)
for an exemption from the electrical licensing and certification requirements of RCW 19.28 by t
submission of this affidavit.
Which'statement describes you? (Mark only One If none apply,you may not take out this permit)
A. I own this property. 1
t Your name or your company's name must be shown on the deed to the property. Real estate agents'property i
management companies, relatives, etc. cannot purchase permits for the property owner. -
4
❑ I rent or lease this property. _
1 We need a copy of your rental agreement showing you have permission to perform electrical work
O 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 i
non-compensated appropriately certified electrician.
1
1 Select yourproperty type;(Mark only onife none apply you may nal takeothis perm
ut it)
I ❑ 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,
I personally, and/or a regularly employed employee(s),will be doing the electricalwork.
ElNew 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. 1
i Jai, Existing residential property, place of business,or farm. I,personally,and/or a regularly
1 employed employee(s),will be doing the electrical work.
g
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8T8 AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 Is.www.cityofiederalway.com zs permitcentert cityoffederalway.com
Bulletin#080—June 6,2018 Page 1 of 2 k:\Handouts\Property Owner Electrical Work Application .
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❑ 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 assessedespenalties. ">
l�v vJ �/ vt U V/t-c—
Printed ISame of Property Owner,Renter,or Lessee ignature
� •l5= (.7
Date
operty-*Ii t nd I speetron*Si tiformation
Utn o vvc) �
Property Owner's Name(Last,First)or Company Name
30 6 G 2 j Ave C. C.-) ' tA/ �O S
Mailing Address Unit/Apt.# City Sta e Zip
9.0G -7 3 - ' 620 0 �(.) CtIA Cor.,
Daytime Phone Email Address
30626 2 Aoe S.G.). gee)** �( Lj W4
Inspection Site Address(if different) Unit/Apt.# City State Zip
County Electrical Power Company/Serving Utility
Deseription'of work being done{Example:adding outlets in the kitchen second floor break area,etc:)
d cv , D .i.r- 1-(G#k v P Gi dlJ 'u4"-(e 4-S
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 www.cityoffederalway.com permitcentercityoffederalway.com
Bulletin#080-June 6,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Application