08-101458RECEV LA, 1
CIiY OF �
Federal Way MAC 2 5 200$ PERMIT — r
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN P
33325 B FEDERAL
E SOUTH • PO BOX 9718 TCATI O N
FEDE24L WAY, SVA 98053�7gIp8g
253.835.2607• fiAX 293- 4 � F F �,
walmr.t �-
The following is required info�rin tian —an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS 33y 7 6— " - ' Awe SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # I Q 0 LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) _66G IM
(Attach separate pagefor Lengthy legal de aiphbN
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING V FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this uenn[t onIld
re_ ✓ter ice• 5�1 �!
PROJECT NAME (Name of Business or Owner Last Nara
PEOPLEi •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME��v!i v�. r� Ilaw ; (W )9NE Z
MAILING ADDRESS CCTV, STATE. ZIP E-MM ADDRESS
336,� zow' Ave -.S- w a)'e 00 wCa
COMPANY NAME
uAu# �ler_47G_
APPLC NAME
� J• G[1•Yia1.+
OFFICE PHONE
f�$3l 3S -
�
MAILING ADDRESS
43 Sfr 5.
CL1Y. STATE. ZIP
a wA
CELL PRONE
(r3) oz-
- � Is7v
CITY OF FE-DERAKWAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
?810.s6 oar BG
>c ex-p8
(2253) 393
- 8373
CONTRACTQR'S REGISTRATION NUMBER
Ai�G716-C
F-ICPI ATION DATE
/ 3/�
F MAIL ADDRESS
3 66-11
f�
t G1r��
/rC •C
CO NAME
APPLICANT NAME
OFFICE PHONE
3697
r
::�A 0epGe
(z53) -
MAILING ADPRESS
&be
C , STATE, ZIP
CELL PHONE
003 ) ys 0%3
.a. 0C>Zk
w
-
RELATIONSHIP TO PR JECT
❑ Architect ❑ Tenant ffl�ent ❑ Other
FAXNUMBER
( ) *V,5 - 3/5
NA.1� PRIMARY PHONE E-MAIL ADDRESS
5� IQo G� (Tt3)
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE $
PROPOSED USE
W* VALUE OF PROPOSED WORK
RAT fr"
T"--M
SPRINKLERED BUILDING? • YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REgumR l? BYES ❑ NO
WATER SERVICE PROVIDER HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER Lf LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
0 E PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
Sp. FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
lit
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOTAL ERISTMG SF
TOTAL PROPOSED SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS LV ESTIMATED SELLING PRICE $ E41
14
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATIOM
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS [rollet)
SINKS
WASHING MACHINES
SUMPS
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 [inctudirg, casts, expenses, and attorneys' fees incurred in the
investigation and defense 4f such ciaiml, 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 4f the city, including its q ffxcem and employees, upon the accuracy of the information supplied to
the city as apart of this application.
SIGNATURE:
Owner and/or Authorized Agent
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES o NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 —January 1, 2008 Page 2 of 4 MandoutsTermit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL
NEW RESIDENTIAL SERVICE
❑ Single Family Square Feet
(First 1300 ft2- $115.50; Each add'n 500 ft2 - $37.00)
❑ Detached outbuilding or garage
(Inspected with service) $48.50
❑ Detached outbuilding or garage
(Inspected separately) $76.50
NEW MULTI -FAMILY (three units or more)
Service
Feeder
❑ Up to 200 amp
$125.50
$ 37.00
❑ 201 - 400 amp
155.50
76.50
❑ 401 - 600 amp
212.50
106.00
❑ 601 - 800 amp
272:00
145.50
❑ Over 800 amp
389.50
291.00
ALTERED SINGLE/MULTI FAMILY
Service or Feeder
❑ 0 to 200 amp $ 96.00
❑ 201 - 600 amp 155.50
❑ over 600 amp 234.00
❑ # of circuits to be added/altered
(1-4 circuits-$76.50; Add'n circuits $7.50/ea)
❑ Mast or meter repair $57.50
❑ Service or feeder only $76.50
❑ Service and feeder $125.50
COMMERCIAL
NEw CaMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder EachAdd'n
❑ 0 to 100 amp $125.50 $ 76.50
❑ 101 - 200 amp 155.50 98.00
❑ 201 - 400 amp 291.00 115.00
❑ 401 - 600 amp 339.50 136.00
❑ 601 - 800 amp 439.00 186.00
❑ 801 - 1000 amp 536.50 224.50
❑ Over 1000 amp 584.50 311.50
❑ Over 600 volts surcharge $98.00
❑ Mast or meter repair $106.00
ALTERED COMMERCUM/INDUSTRIAL
Service or Feeders
❑ 0 to 200 amp $125.50
❑ 201 - 600 amp 291.00
❑ 601 - 1000 amp 439.00
❑ over 1000 amp 489.00
❑ # of circuits to be added/altered
(1-5 circuits - $98.00; Add'n circuits, $7.50/ea)
COMMERCIALANDUSTRTAL PLAN REVIEW
$98.00 plus 35% of Permit Fee
❑ Service - 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
TEMPORARY SERVICE
MOBILE_HOME/RV PARK
Residential/Multi-Family
$67.50
❑ # of service or feeders
(First service/feeder-$76.50; each addh-$50.00)
Commercial/industrial Service or Feeder Ampacity
❑ 0 - 100 amps
$ 76.50
❑ 101 - 200 amps
98.00
❑ 201 - 400 amps
115.00
❑ 401 - 600 amps
155.50
❑ over 600 amps
168.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ # of Thermostats
(First-$57.50; add'n-$17.50/ea)
X, Low Voltage e PtFeet to be served by system(s) �/ 667�`
Fire Alarm System
❑ Security Alarm System
❑ Voice Cabling
❑ Data Cabling
13
1.12500 ft2-$67.50;
Each add'n 2500 ft2 - $17.50) • Per wAc 296116-91 o(5)(b)(i & iJ
❑ # of Signs
(First sign-$57.50; add'n sign $27.00/ea)
❑ Swimming pool/hot tub ................
pncludes additional circuit, if required)
❑ Yard Pole meter loops .....................
❑ Additional Plan Review
(for modified submittals)
❑ Automation Fee on all Permits ..
$115.00
$76.50
$115.00/hour
$5.50
Bulletin #100 -January 1, 2008 Page 3 of 4 k\Handouts\Pemut Application