19-102828 f K
Electrical
City of Federal Way Permit #:19-102828-00-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: GIBSON
Project Address: 3123 SW 302ND PL Parcel Number:012103 9080
Project Description: Adding outlets,lighting and switches for bathroom remodels.
Owner Applicant Contractor
JAMIE GIBSON JAMIE GIBSON OWNER IS CONTRACTOR
3123 SW 302ND PL 3123 SW 302ND PL
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Additional Permit Information
Is this an Online or O.T.C.application? Yes
a sae aw
Circuits-Residential 4
PERMIT EXPIRES Wednesday,10 June,2020
Permit Issued on Tuesday,June 11,2019
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
Washingto and thq City of Federal Way. o
Owner or agent: Date: (� -1
THIS CARD IS TO REMAIN ON-SITE
CITY OP Federal ' Construction Inspection Record
Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 19 102828 00 Address: 3123 SW 302ND PL
Project: JAMIE GIBSON FEDERAL WAY WA 98023-2342
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.
Q UFER Ground(4295) Q Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
•
Pool Bonding(4195) ® Temporary Power(4275) s❑ Service(4235)
Approved Approved Approved
By Date •. B• y Date I By Date
® Feeders/Sub-panels(4045) ® Rough Electrical(4225) ® Ceiling Cover(4020)
Approved Approved �j Approved
By Date By r� Date74-'//1", 1 By Date
,
El Final-Electrical(4055)
Approved
By rie Date 71,4221,,,
•
--;,:.
0 Rough Electrical 0 Final Electrical ❑ Right of Way
Approved Approved Approved
By Date By Date By Date
9L, € D ELECTRICAL
CITY OF ^.. �
Federal Way JUN PERMIT APPLICATION
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D E1Lpm4EN; l
ERMIT NUMBER / / _ I 0 ,3).. 2 ,98. _ s.. L
SUITE/UNIT/SPACE#
SITE ADDRESS: 3 ( 5 -,)��� pL
PROJECT VALUATION ASSESSOR'S TAX/PARCEL## CURRENT/PROPOSED USE
$ DO DIS. / a 3 - g OR a
PROJECT NAME
(Tenant or Homeowner Last Name) _,-'21...\--7, 1\--5-.)--.1 /�' )�-4__ .V �`1;/
PROJECT DESCRIPTION Nevi4t"�
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ____)(NY)) 6)-)3c-7- 0 NI 04,6)461) )LIM
MAILINGjjADDRESS ` E-MAIL
c YS TE ZIP FAX G. (A�y
u4 M� x'18 ,,3 ( ) __ !!
• NAME PRIMARY PHONE
__-► 7 C JJ� N);1IL-• ( ) -
MAILING ADIIRESS E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( )
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME ,, ..\\(� PRIMARY PHONE
APPLICANT Ow "``-- ( )
MAILING ADDR'''' 'tC**(SS E-MAIL
CITY STATE ZIP FAX
( )
NAME � PRIMARY PHONE
PROJECT CONTACT `� i G 1 1 \fi 2.0b)49 y -1L1
i i4
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: `� AIlk
4 DATE Ii
PRINT NAME: t i 1 e 111
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
«�YaFAihr. Property Owner
p Y
Federal Way Electrical Work Permit Application
Applying'For siT9ur'Electrical P, emit
In Washington, only licensed electrical contractors may perform electrical work. Property owners t
may apply for an exemption from these requirements by completing this application and signing I.
fithe affidavit below before beginning electrical work.
L
t' : clavi. y Fi
x
As authorized under RCW 19.28.261, I, ( .)NM,1E (113 c�U 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 1 -
submission of this affidavit.
'Which statement describes you? (mark only one If none apply you may not take out this permit)
WI own this property. ..� __.....a:_
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.
1 ❑ I rent or lease this property.
IWe 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 d `
one by a
i 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
i at least 24 months after completing the electrical work. I will be personally doing the electrical
work.
i
❑ New 2,3,or 4 unit residential building,owned by me,that is intended for rent, sale, or lease. I
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 otherproperty: new structure that is not intended for rent,
Any
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 1
`�
i 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 Is.www.cityoffederalway.com zs permitcenterc cityoffederalway.com
Bulletin#080—June 6,2018 . Page 1 of 2 k:\Handouts\Property Owner Electrical Work Application
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
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
i 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 'ay be assessed penalties.
( kV:—__N__a. _ �S521\, 'S A AA1 1 ii ,.,._. .,.
Printed Name of Property Owner,Renter,or Lee ` Signature
Date
ili
,, t. Property--Qw �e nd I-n
nspeettoiNfkif oo i rmati4. `�
k �'".r`- �'' -i vii m
Property Owner's Name(Last,First)or Company Name
Mailing!Adddrless Unit/Apt.# City Stat Zip
ii
Daytime Phone Email Address
MA) L. .
Inspection Site Address(if different) Unit/Apt.# City State Zip
F
County Electrical Power Company/Serving Utility
Description of work being dobe(Example:adding outlets in'ihelcitchen second floor break area,•etc.), ;"
1N��W\ ( C–) i C _ \6– )A-1-1 Gv f_____
i
DEPARTMENT OF COMMUNITY DEVELOPMENT/33325 8TH AVENUE SOUTH/FEDERAL WAY,WA 98003-6325
253-835-2607 www.cityoffederalway.corn permitcenter(a�cityoffederalway.com
Bulletin#080–June 6,2018 Page 2 of 2 k:\Handoutsl Property Owner Electrical Work Application