20-101084 Electrical
City Federal Way Permit #:20-101084-00-EL
Community y 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: LOURDES LOVING CARE ADULT FAMILY HOME LLC
Project Address: 30442 8TH AVE S Parcel Number:091800 0030
Project Description: Add(2)outlets& (2)smoke/Co2 detectors.
Owner Applicant Contractor
LOURDES SAMPAYAN LOURDES SAMPAYAN OWNER IS CONTRACTOR
30442 8TH AVE S 30442 8TH AVE S
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
Additional Permit Information
Is this an Online or O.T.C.application9 Yes
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Circuits-Residential 2
PERMIT EXPIRES Tuesday,9 March,2021
Permit Issued on Monday,March 9,2020
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: a �`� Date: t-23V�/241
THIS CARD IS TO REMAIN ON-SITE
CITY OF Construction Inspection Record
Federal Way INSPECTION REQUESTS:(253)835-3050
PERMIT#: 20 101084 00 Address: 30442 8TH AVE S
Project: LOURDES SAMPAYAN FEDERAL WAY WA 98003-4113
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) ED Ditch cover(4030) j Q Slab/Concrete Floor(4255)
Approved Approved I Approved to place concrete
I
By Date By Date ' By Date
'•
• I Pool Bonding(4195) El Temporary Power(4275) .' w
El Service(4235)
Approved Approved Approved
By Date By Date By Date
® Feeders/Sub-panels(4045) ® Rough Electrical(4225) ` 9❑ Ceiling Cover(4020)
Approved icor
^Na Approved A ' Approved
By Date ! By tisk Date 3-)49-, D By Date
0 Final-Electrical(4055)
Qe, (t__- (�,•Approved
•
By R v., Date s-0 o)a
❑ Rough Electrical .CI Final Electrical 0 Right of Way
Approved Approved Approved
By Date By Date By Date
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1N3Wdo13A3aMJNflVO Co ELECTRICAL
CITY OF �.loor AVM 1VH3ad dO A0.I0
Federal Way oZoz o ��w PERMIT APPLICATION
a 3/1 I. a)3 L.1 PERMIT NUMBER A ( — I 0''' -- i C Ci TV
c� ,.. SUITE/UNIT/SPACE#
SITE ADDRESS: t7 y Z Z5 O1 1��' 1/1e - t 4 ( UiA y "41
PROJECT VALUATION ASSESSOR'S TAX/PARCEL# CURRENT/PROPOSED USE
•
$ 4:57 (3 V _ _ -
PROJECT NAME C
(Tenant or Homeowner Last Name) C� ( 4 (2. �'t r° Lov; i'i1Cve /i
PROJECT DESCRIPTION ..11-bb � Q-7140 h,n th ax`
Detailed description of work to A l/5 V
be included on this permit only
NAME _p PRIMARY PHONE
PROPERTY OWNER -( -i 5 S m �F ( 2 -)J 13 - )U I-
MAILING ADDRESS E-MAIL
30 2 Q 1-I--) /1 U e log crtd, L7 5,5 yAnaii'
CITY STATE ZIP FAX
'F. -c>/c-1--a--( uAy LL)A ' Yo (' ) -
NAME PRIMARY PHONE
MAILING DRESS ���.� E-MAIL
ELECTRICAL
CONTRACTOR CITY STATE ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME AL PRIMARY PHONE
APPLICANT `j'-' ` "`'' - ( )
MAILING S E-MAIL
CITY STATE ZIP FAX
( )
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�ie� /-tt o the cityass a part of this application.
SIGNATURE: ""10 s ` DATE D3/1---) J/(.)
PRINT NAME:
Bulletin#160—April 14,2016 Page 1 of 1 k:\Handouts\Electrical Permit Application
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CITY OF _.„...._ ..4.
Property Owner
Federal Way Electrical Work Permit Affidavit
For Voir: rica`i Permit
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.
Affidavit
As authorized under RCW 19.28.261, I,
(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.)
t ElNew 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.
1 ❑ 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.
CI New 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.
PC. 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 i,.www.cityoffederalway.com-N.permitcenter(a�cityoffederalway.com
Bulletin#170—July 27,2018 Page 1 of 2 k:\Handouts\Property Owner Electrical Work Affidavit
4. 111
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:
1 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.
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Signature % a Date
VII GZI,dg" s�/141A7 N
Printed Name of Property Owner,Renter,or Lessee
Property Owner and Inspection Site information
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(, of /eS L-o J r)g CC,-e f/
Property Owner's Name or Company Name
Mailing Address Unit/Apt.# City State Zip I
R2 )313 - //0- _. /ou"--de<6 0,,o4-crs 6 y/2-24,7• C.t----
Daytime Phone Email Address
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Inspection Site Address Unit/Apt.#
Electrical Power Company/Serving Utility
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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'N.www.cityoffederalway.com is permitcenter@cityoffederalway.com
Bulletin#170—July 27,2018 Page 2 of 2 k:\Handouts\Property Owner Electrical Work Affidavit