08-101834South King Fire t
RECEIVED Appravel -A 0 - g-s (�
Federal Way PE t �led F MF CO ME EL PL DE E P
COMMUNITY DEVELOPMENT SERVICES APR 17IOPLICATION-
tO attached d of 2 i 15�
33325 DEAVENUE SOUTH • 63 BOX 9718 FEDERAL WAY, WA 98063-9718 �rv�258QF FEDERAL --+
rnuny.rltrrnlfrdemlt . WAY �dn �! ' EC
The following is required i.f�>�n - an incomplete applies w� I a epted. Please print legibly (in ink) or type.
SITE ADDRESS 33 y Ave— - SUITE/UNIT #
ASSESSOR'S TAX/PARCEL 0 ' a y - 90 0 eLOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I)
(Attach separate page for lengthy legal descrlptlaN
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING LWFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit ontul
� r � 1z 5 -` �t i rr �. .. die de ■' �
wr' 1 'r C'i rt,I r
PROJECT NAME (Name of Business or Owner Last Name) ►ter GL+�7
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
E PEOPLE INFORMATION
NAME
PRIMARY PHONE
MAILINGADDRESS
���' h �-
ORY. STATE ZIP WA �
E"MNL ADIIR.GS5
COMPANY NAME
PLICANT NAME
OFFTCE PHON E
83Z
lh
Zp6 ) -
MAILING ADDRESS
�L i Ave—
cm, MTE, ZIP
lrJ 3
CELL PHONE
] z -
CrrYOF FEDERAL WAY BUSINISS LICENSE Nl1MBER
EXPIRKDON DATE
FAX NUMBER
() 45? -/
/9— —05�W cr3 —
1z 31 —08
Zc,
CONTRACTOR'S REGISTRATION NUMBER
S%PIRATION DATE
E-MAIL ADDRESS
14/
•'OL
JK-10
I
COMP AME
APPLICANT NAME
OFFICE PHONE
fociAver--
MAILING AD DRXSS r
STATE 7.11P
CELL PHONE
y v1,3
r5a
MAMONSHIP TO PROJECT
FAX NUMBER
ElArchitect ❑ Tenant Agerst ❑ Other
NAME
NAME Per RCW 19.27.095:
Lender information is required 4f project value exceeds $5,000
f MAILING ADDRESS I CITY. STATE, ZIP PHONE
PROPOSED USE/ kIA ZE
EXISTING ASSESSED/APPRAISED V UE $ �/W VALUE OF PROPOSED WORK $ S �
SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? � ❑ NO
WATER SERVICE PROVIDER HAVEN 0 HIGHLINE 0 TACOMA El PRIVATE (WELL)
SEWER SERVICE PROVIDER �EHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
Um
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST X&a
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
ERIS INZ_G
PROPOSED
—AL7dr
SF
TOTAL PROPOSED SF
/ TOTAI,
**NEW HOMES ONLY** NUMBER OF BEDROOMS % ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing factures to remain.
MECHANICAL
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE 17VCLUDED WITH APPLICATION)
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
I'l,I3NIBM
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 rronet)
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 responsibilityfor compliance with local, state, orfederal 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 4f 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:
ter and/or Authorized
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Pernut Application
ELECTRICAL PERMIT INFORMATION
I:V*3111DKO4/_al�f
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/MIIL'TI 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
MANUFACTURED HOMES
❑ Service or feeder only $76.50
❑ Service and feeder $125.50
COMMERCIAL
NEW COMMERCIAL11NDUSTR[Ai.6ERVIC1r
❑ 0 to 100 amp
❑ 101 - 200 amp
❑ 201 - 400 amp
❑ 401 - 600 amp
❑ 601 - 800 amp
❑ 801 - 1000 amp
❑ Over 1000 amp
Service or Feeder
Each Add'n
$125.50
$ 76.50
155.50
98.00
291.00
115.00
339.50
136.00
439.00
186.00
536.50
224.50
584.50
311.50
❑ Over 600 volts surcharge $98.00
❑ Mast or meter repair $106.00
ALTERED COMMERCIAL NDU$TRIAT.
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)
COMMERCIALnNDUSTRIAL 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 add'n-$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)
❑ Low Voltage
Square Feet to be served by system(s)
❑ Fire Alarm System
❑ Security Alarm System
❑ Voice Cabling
❑ Data Cabling
I-L 2500 ft2-$67.50;
Each add'n 2500 ft2 - $17.50) • Per WAC 29646-910(5)(b)(i & it)
❑ # of Signs
(First sign-$57.50; add'n sign $27.00/ea)
❑ Swimming pool/hot tub ................
(Includes 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\-landouts\Permit Application