05-102339Tr OF 0 I 1 0 2 - iRMIt
Federal way �PTAl\�� ZO�� SF MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES l
3332FEDERAAVENUE SOUTH 98063971 9718 APPLI CA' I �.N ,��� A� �
FEDERAL WAY, WA 53-8 3 -260
253.835-2607• FAX 253-835-2609
I9L'JI*. IrglMtLrrd,iwll.lrnn i �, •:3 DEPT,
The fallowing is required information -an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS S - C77 SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # I y - LOT SIZE (sfi
�3
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) V Y' A 1 Fc- � _� �l A Ok k, ` �z S .
(Allach separate page jor lengthy legal d0svfpl(Wk1
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit oriluJ
FIY-E A V v lM 6 xs-�'_vyi PG �,- CU r A 1 t, (I' _0A C0- _0U - G� .
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
OC r_ - 1
MAIL G ADD ` S CITY, STA'I! . '-IP
AOMPANY NA{ISF_ APPUCANT NAME OFFICE „HONE 7 7 - & ` C
MAILING ADD EnT. STATE. ZIP ^ E L PHONE
r
CrrYWFEDERALYAYBUSIN LICENSE NUMBER C"MAMON DATE FAX NUMBER
111-91. --i U .5(-(j6 -I, I, P -
NTRACTOR'S REGISTRAMON NUMBER Icof card required with each applleationi EXPIRNnON DATE o y
YMPANY NAME
LiCANF NAME
OFFICE PHONE
M,tLLNb Ap
CI'i , STATE. ZIP
CELL PHONE
RELATI SHIA PROJECT
❑ Architect ❑ Tenant Agent ❑ Other (Describe)
FAX NUMBER
( ] -
WE
PRIMARY PHONE
EMAIL ADDRESS
Per RCW 19.27.095: Lender information is NAME v a v_CL( 4n
required ifproject value exceeds $5,000
MAILING ADDRESS CITY, STATE, ZIP
EXISTING USE _ PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE S VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE (SEPTIC)
�I j
t Dytti
n
AREA DESCRIPTION
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
EXI
NUMBER OF FLOORS
NEW HOMES ONLY" NUMBER OF
PROPOSED I TOTAL
EXISTING
SQ. FT.
SF
ESTIMATED SELLING PRICE
PROPOSED
SQ. FT.
TOTAL PROPOSED SF
TOTAL
TOTAL SF
Indicate number of each type or.Axture to be installed or relocated as part of this project. Do not include existingfixtures to remain.
MECHANICAL 'I
Value of Mechanical Work 5 i
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS reamroumSh-&A
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Touet)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the i0ormation furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the curner 4f the above premises to perform the u*rk 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 inuestigation and defense of
such claim), which may be made by any person, including the undersigned, and feted against the City of Federal Way, but onig cohere 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 2f
this application. `
NAME/TITLE C i DATE - 1
(Signature) (Title
RELATIONSHIP TO PR ❑ Owner Agent Contractor hltec)t ❑ Other
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
PLATTED LOT?
Bulletin #100 — January 7, 2005
❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
❑ YES ❑ NO BASIC PLAN? a YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
❑ YES ❑ NO UP/SEPA/SU? ❑ YES ❑ NO
❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO
Page 2 of 4
k\Handouts\Permit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL
NEW RESIDENTIAL SERVICE
❑ Single Family Square Feet
(First 1300 ft2- $104.50; Each add'n 500 ft2 - $33.50)
❑ Detached outbuilding or garage
(Inspected with service) $44.00
❑ Detached outbuilding or garage
(Inspected separately) $69.50
NEW MULTI -FAMILY (three units or more)
Service
Feeder
❑ Up to 200 amp
$113.50
$ 33.50
❑ 201 - 400 amp
141.00
69.50
❑ 401 - 600 amp
193.00
96.00
0 601 - 800 amp
247.00
132.00
❑ Over 800 amp
353.50
264.50
ALTERED SINGLE/MULTI FAMILY
Service or Feeder
❑ 0 to 200 amp
$ 87.00
❑ 201 - 600 amp
141.00
❑ over 600 amp
212.50
❑ # of circuits to be added/altered
(1-4 circuits-$69.50; Add'n circuits $7.00/ea)
❑ Mast or meter repair $52.00
MOBILE HOMES
❑ Service or feeder only $69.50
❑ Service and feeder $113.50
COMMERCIAL
NEW COMMERCIALIINDUSTRIAL SERVICE
Service or Feeder EachAdd'n
❑ 0 to 100 amp $113.50 $ 69.50
❑ 101 - 200 amp 141.00 89.00
❑ 201 - 400 amp 264.50 104.00
❑ 401 - 600 amp 308.00 123.50
❑ 601 - 800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
❑ Over 1000 amp 530.50 283.00
❑ Over 600 volts surcharge $89.00
❑ Mast or meter repair $96.00
ALTERED COMMERCIAL/INDUSTRIe1-
Service or Feeders
❑ 0 to 200 amp $113.50
❑ 201 - 600 amp 264.50
❑ 601 - 1000 amp 398.50
❑ over 1000 amp 443.50
❑ # of circuits to be added/altered
(1-5 circuits - $89.00; Add'n circuits, $7.00/ea)
COM WRCIAL/IIiIDUSTRL4,L PLAN REVIEW
$89.00 plus 35% of Permit Fee
❑ Service - 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
TEMPORARY SERVICE
MOBILE HOW/RV PARK
Residential/Multi-Family
$61.00
❑ # of service or feeders
(First service/feeder-$69.50; each add'n-$45.00)
Commercial/Industrial Service or Feeder Ampacity
❑ 0 - 100 amps
$ 69.50
❑ 101 - 200 amps
89.00
❑ 201 - 400 amps
104.50
❑ 401 - 600 amps
141.00
❑ over 600 amps
152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑ # of Thermostats
r (First $52.00; add'n-$16.00/ea)
Low Voltage
S e Feet to be served by system(s) 1 J�
•tom Firc Alarm System
❑ Security Alarm System
❑ Voice Cabling
❑ Data Cabling
1-1
(Per System(s) 1s( 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) 1 Per WAC 296-46-91 o(5)(b)(i &. U)
❑ # of Signs
(First sign-$52.00; add'n sign $24.50/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 ..
$87.00
$104.50
$104.50/hour
$5.00
Bulletin #100 - January 7, 2005 Page 3 of 4 k\Handouts\Permit Application