07-100329 Rf: EIVEp f( - l ,0 0 3'
Federal way PERMIT '
COMMUMTY DEVELOPMENTSERVEC�5/I _ .SF MF ME(P�LJ La;-ODE EN FP
33325'8",DERAL WAY,WA7W•PODOX OM N 2 2 20APPLICATION TD ��
FEDERAL WAY, X 98063-9718 / /
T53-83ST607•PAX 253-8�[,.('�p�q
wyw.dlw(federaheae.caaf ' OF Fm...- . .
The following is required" th4 pnA an incomplete application will not be accepted. Please print legibly(in ink)or type.
S PROPERTY INFORMATION
3 SITE ADDRESS I (}ra iiv c7 y
t SUITE/UNIT R
ASSESSOR'S TAX/PARCEL# L/_ 0. 0 ( j 6 - I (,)
LOT:SIZE(s•/)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal da(ripein)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION (ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)l
../.. .7,524/7 • ri. ./..'LL/lt! PROJECT NAME(Name of Business or Owner Last Name) if i!.�. I A 0 4— ...�._L.
1 _ - (.PEOPLE INFORMATION
•
•OWNER
PROPERTY NAME 3,7/ �/. /'/ /t PRIMARY PHONE -
MAILINGNG AD�. •`/-•it. \ l/ it'/t• CITY,STATE,ZIP EMAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME - OFFICE PHONE
L 60)1 i�4r.U-ud If) ryV�yCleo
- . ,d1 CITY,• 'i '. wido ( y'. cI '7/- 4Z:3 7
MAILING/1 -J!FSs //✓y Y5 �V• C/ ,5•MTE�/� e�J, CELL -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER / 'yY/ RATION DATE /G�f FAX NUMBER
• Zooc I06z/63 ( ) -
CONTRA C TOR'SREGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
CwY of G curvd rogro `/5 kIKb fG- — •
K1-
APPLICANT COMPANY NAME /y APPLICANT NAME (`OFFICE PHONE)
`
MAILING ADDRESS - ' CITY,STATE,ZIP CELL PHONE
(
RELATIONSHIP TO PROJECT FAX NUMBER •
0 Architect 0 Tenant 0 Agent [J Other ( ) -
PROJECT NAME /i / ! PRIMARY PHONE n f / E-MAIL ADDRESS
CONTACT �r1i1 Alder-soil ( )3 f'7 - 2 03 7
LENDER NAME Per RCW 19,27.095:
Lender information is required(/project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE -
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑PRIVATE(SEPTIC)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
•
BASEMENT SQ•FT. ,, SQ.FT. SQ.FT.
FIRST — —
SECOND –
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS sa°srmo PROPOSED I TOTAL TOTAL 670817N6 el TOTAL PROPOSED St TOTAL ALT
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
1
■ FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures io remain.
MECIAANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Conmerd.y
COMPRESSORS FURNACES RANGES
DUB, GAS LOG SETS . . REFRIO.SYSTEMS
PLUMBING
BATHTUBS(or Tub/ShowerCombol LAVS iee°uuomsinks) URINALS MISC(Describe)
DISHWASHERS ` RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toney
ELECTRIC WATER HEATERS SINKS - WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 flied against the City of Federal Way,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.
NAME/TITLE -- DATE /
(signature) (Title)
RELATIONSHIP TO PROJECT ❑ O er o Agent ❑ Contractor ❑ Architect o Other
0 NEW ❑ADDITION o ALTERATION a REPAIR oTENANT IMPROVEMENT .
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? a YES a NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
•
Bulletin#100–January li2007 Page2of4 kUiandouts\PermitApplication
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... .. , . . ELECTRICAL PERMIT INFORI ON
r RESIDENTIAL 11 COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(Fret 1300 fts-$111.00;Each add'n 500 fts-$35.50) ❑ 0 to 100 amp $120.50 $74.00
❑ Detached outbuilding or garage ❑ 101-200 amp 149.50 94.50
(Inspected with service) ,, $47.00 ❑ 201 -400 amp 280.00 111.00
❑ Detached outbuilding or garage ❑ 401-600 amp 327.00 131.00
(Inspected separately) $74.00 ❑ 601-800 amp 423.00 179.00
❑ 801 - 1000 amp 516.50 216.00
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 563.00 300.00
Service Feeder
❑ Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50
❑ 201 -400 amp 149.50 74.00 ❑ Mast or meter repair $102.00
❑ 401 - 600 amp 205.00 102.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 262.00 140.50
❑ Over 800 amp 375.50 280.50 Service or Feeders
❑ 0 to 200 amp $120.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 280.50
❑ 601 - 1000 amp 423.00
Service or Feeder ❑ over 1000 amp 471.00
❑ 0 to 200 amp $92.50
❑ 201 - 600 amp 149.50 ❑ 4 of circuits to be added/altered
❑ over 600 amp :225.50 - (1-5 circuits-$94.50;Add'n circuits,$7.00/ea)
❑ 4 of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$74.00;Add'n circuits$7.00/ea) $94.50 plus 35%of Permit Fee
❑ Service - 1;000 amps or greater
❑ Mast or meter repair $55.00 ❑ Medical/Educational/institutional Facility
MANUFACTURED HOMES
❑ Service or feeder only $74.00 •
❑ Service and feeder $120.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $65.00
❑ #of service or feeders
(First service/feeder-$74.00;each add'n-$48.00) Commercial/Industrial Service or Feeder.Ampacity
❑ 0- 100 amps $74.00
❑ 101-200 amps 94.50
❑ 201-400 amps 111.00 ,
❑ 401-600 amps 149.50
- ❑ over 600 amps ' 162.00
MISCELLANEOUS SERVICE/EQUIPMENT .
❑ 4 of Thermostats ❑ ii of Signs
(First-$55.00;add'n-$17.00/ea) ' (First sign-$55.00;add'n sign$26.00/ea)
❑ Low Voltage Z ❑ Swimming pool/hot tub $111.00
Square Feet to be served by system(s) ! (Includes additional circuit,if required)
El Fire Alarm System ❑ Yard Pole meter loops $74.00 '
❑ Security Alarm System ❑ Additional Plan Review $111.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00
1•'2500 fts-$65.00;
Each add'n 2500 10 17.00) •Per WAC 296.46.97015)(b)ti b ii)
Bulletin 11100-January I,2007 . Page 3 of 4 k\Handouts\Permit Application