06-101172r
City of Federal Way
Community Development Services Electrical Permit #: 06- 101172 -00 -EL
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -2607 Fax: (253) 835 -2609 Inspection Request Line: (253) 835-3050
Project Name: LIFE CARE CENTERS OF AMERICA
Project Address: 33801 1ST WAY S Suite 301 Parcel Number: 926504 0160
Project Description: Addition of (3) circuits for new TI
Owner
Applicant
Contractor
STAN KLEWENO
LAZER ELECTRIC
LAZER ELECTRIC
TRANSPACIFIC INVESTMENTS
9253 19TH AVE E
LAZEREI033DF 03/04/05
101 SW MAIN ST SUITE 350
TACOMA WA 98445
9253 19TH AVE E
PORTLAND OR 97204
TACOMA WA 98445
PERMIT EXPIRES Saturday, September 9, 2006
Permit Issued on Monday, March 13, 2006
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 t e laws, rules and regulations of the State of Washington
n the Ci of Federal Way.
Owner or agent: �,C/ Date:
�3 ��
THIS CARD IS TO REMAIN ON -SITE
C1.TY QF Community Development Inspection Record -
FerI Way IVR INSPECTION REQUEST PHONE # (253) 835 -3050
PERMIT #: 06- 101172 -00 -EL
Owner: STAN KLEWENO
Address: 33801 1 ST WAY S Suite 301
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. Scheduled inspections maybe 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.
❑ Slab /Concrete Floor (4255) 13 Ditch cover (4030) ❑ Pool Bonding (4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power (4275) ❑ Service (4235) ❑ Feeders /Sub - panels (4045)
Approved Approved Approved
By Date By Date By Date
Rough Electrical (4225) Ceiling Cover (4020) ❑ Fi - Electrical (4055)
Approved Approved Approved
By 0 Date U _Q-1_ p b By Date n 3 _ y Date r--
❑ Under -slab groundwork (4295)
Approved
By Date
•
«TMa CONSTRUCTION PERMIT APPLICATION
PPUCATION NUMBER:
PLICATION NUMBER ;' -
PPUrAt6h NUMBER:
* *The following is required information — Please print (in ink) or type **
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
/ PROPERTY •• •
SITE ADDRESS: t) r ASSESSOR'S TAX /PARCEL #: �_ Z_ �d L/ d j-
(� O
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
PROJECT 0 •• •
TYPE OF PROJECT (This application): o BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
1/19LECTRICALj� r c
❑,�ENGINEERING ❑ FIRE PREVENTION SYSTEM
�-i-
PROJECT DESCRIPTION (Provide detailed description): y` S �� � � a e:` ) 6
PROJECT NAME:
PROPERTY OWNER:
CONTRACTOR:
APPLICANT:
'� c--
o + Amt- c-,9
■ PEOPLE INFORMATION
NAM DAYTIME PHONE:
MAILING ADDRESS (SnEET ADDRESS; CITY, STATE, ZIP):
1 Flo t I�^-� . 4 u c
NAME:
z � r <c-
DAYTIME PHONE:
(2SXs3s - L
MAILING ADDRESS (STREET QDD ESS; CITY, STATE, ZIP):
q,5 c /4Ve. E YYS
EVENING PHONE:
V-S-3) 7ZZ -S97s
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
_____ _ __ _
FAX NUMBER:
(��)53� -yet!/
CONTRACTOR'S REGISTRATION NUMBER: /� J /y� j�
L- Z- T S 1/
IXPI ON DATE:
/ y / o
(copy of card required) �'1 = (%
NAME:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
RELATIONSHIP TO PROJECT:
o ARCHITECT o TENANT
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNS
EVENING PHONE:
( )
j FAX NUMBER:
R ( DESCRIBE): -
E -MAIL ADDRESS:
R ❑ APPLICANT * ONTRACTOR
EXISTING BUILDING ASSESSED /APPRAISED VALUATION
PROPOSED USE:
PROPOSED VALUATION FOR IMPROVEMENTS: $ -N- Re)069 C> C)
SPRINKLERED BUILDING? �IYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: )4AKEHAVEN o HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: LAKEHAVEN o HIGHLINE ❑ PRIVATE (SEPTIC)
J4
* *NEW RESIDENTIAL CONSTRUCTION ONLY **
k
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: #
■ PROJECT FLOOR AREAS
FLOOR
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
FAN(S)
HOOD(S)
WOODSTOVE(S)
FIRST
FIREPLACEINSERT(S)
RANGE(S)
MISC.(
SECOND
FURNACE(S)
THIRD
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
•
FOURTH
PLUMBING
OTHER FLOORS (DESCRIBE)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DECK
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
GARAGE
HOW MANY FLOORS?
SHOWER(S)
WASH MACHINE OUTLET
TOTAL:
SINKS)
WATER CLOSET(S)
MISC.
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S)
EVAPORATIVE COOLER(S)
GAS LOG(S)
REFRIG. SYSTEM(S)
BBQ(S)
FAN(S)
HOOD(S)
WOODSTOVE(S)
BOILER(S)
FIREPLACEINSERT(S)
RANGE(S)
MISC.(
COMPRESSOR(S)
FURNACE(S)
DUCT(S)
GAS PIPE OUTLET(S)
HEAT SOURCE:
❑ ELECTRIC ❑ GAS
•
PLUMBING
BATHTUB(S)
LAVATORY(S)
URINAL(S)
WATER HEATER(S)
DISHWASHER(S)
RAIN WATER SYS.
VACUUM BREAKER(S)
❑ ELECTRIC ❑ GAS
DRINKING FOUNTAINS)
SHOWER(S)
WASH MACHINE OUTLET
GAS PIPE OUTLET(S)
SINKS)
WATER CLOSET(S)
MISC.
INTERCEPTORS)
SUMP(S) ►
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 agre hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the
investigation defense su claim), which may be made by any person, including the undersigned, and filed against the City of
Federal Way, t h suc ai es out of the reliance of the city, including its officers and employees, upon the accuracy
of the inform pli t th ci s rt of this applicat-
NAME /TITLE: DATE:
❑ PROPERTY O ER APPLICANT ❑CONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063 -9718 • 253- 661 -4000 • FAX: 253- 661 -4129
www.citvoffederalway.com
•
•
■ ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES
MOBILE HOMES
MISC EQUIPMENT/TEMP SERVICES
Single Family
— Service or feeder only .. .........................$50.00
_ # of Thermostats (First - $37.50; add'n-$11.SOea)
_
(First 1300 ft?- $75.00; Each add'n 500 ft - $24.00)
Service and feeder .. ............................... $81.00
_ # of Low voltage fire or burglar alarms
Square Feet:
!
First 2500 ft- $43.50; Each add'n 2500 f?-$11.50
Each outbuilding or garage ............................ $31.00
MOBILE HOME /RV PARK
Square Feet:
_
(Inspected with service)
# of service or feeders
' Per W AC 296-46-9 1 0(5)(b)(i & ii)
Each outbuilding or garage ............................ $50.00
_
(First service /feeder- $50.00; Add'n service/
_ # of Signs (First sign - $37.50; add'n sign
_
(Inspected separately)
feeder -$32 each)
$17.50 each)
_ Swimming pool, hot tub, spa ................$75.00
_ Yard Pole meter loops . .........................$50.00
NEW MULTI - FAMILY
COMMERCIAL /INDUSTRIAL
COMMERCIAL /INDUSTRIAL
(Includes three units or more)
Altered Service or Feeders
Service Feeder
Amps Service or Add'n
_ 0 to 200 ............. .... ....... ..... .... .............. S 81.00
Up to 200 amp ............... $ 81.00................. $ 24.00
Feeder
— 201-600 ...................... .........................189.00
201 - 400 amp ............. ....101.00..................... 50.00
0 to 100 ......................... $ 81.00........ $ 50.00
_ 601-1000 ............................................. 284.50
_
401 - 600 amp ............. ....138.00..................... 68.50
_^ 101 -200 ........................ 101.00............63.50
_ over 1000 ..................... .........................317.00
601 - 800 amp ............. ....176.50..................... 94.50
_ 201-400 ........................ 189.00............ 75.00
# of circuits
_
Over 800 amp .................. 252.50...................189.00
_ 401 -600 ........................ 220.50............ 88.50
(1 -5 circuits - $63.50; Add =n circuits, $5 ea)
_
ALTERED SINGLE /MULTI FAMILY
_ 601 - 800___ ..... ____ ... 284.50 .......... 120.50
(When inspected separately from the services.)
_ 801-1000 ...................... 348.00 .......... 145.50
TEMPORARY SERVICE
Service or Feeder
—Over 1000 ...................... 379.00 .......... 202.50
Residential /Multi- Family /Commercial/Industrial
0 to 200 amp ................. ............................... $ 68.50
, Over 600 volts surcharge ........................ 63.50
0-100 ............................. .......... _ ... _S 50.00
_
201 - 600 amp ................. ............................... 101.00
_ Mast or meter repair ..... ..........................68.50
_ 101-200 ....................... ..........................63.50
_
over 600 amp .................. ............................... 151.50
_ 201 -400 ....................... ..........................75.00
Mast or meter repair .......... ............................... 37.50
_ 401 -600 ...................... .........................101.00
~_ # of circuits
_ over 600 ....................... .........................109.00
(1-4 circuits - $50.00; Add'n circuits $5 ea)
It anew or aiterea commercial service is tuu amps or greater, or anew or anerea resiaenua, serv,ca ,b gm- -
permit fee +$63.50. Add -1 plan review for other submissions is $75.001hr.
FIXTURE DESCRIPTION A FIXTURE FE"ROM TABLE B B NUMBER OF UNITS C TOTAL D
TOTAL COLUMN (D):
Estimated Permit Fee: (12)
Total Column (0)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50 + ( X .35) = (13)
Estimated Permit Fee: (14)
Bond Amount: (15)
Estimated Permit Fee: (16)
Bond Amount: (17)
■ DEMOLITION
■ OTHER FEES
Mitigation Fee: (18) (20) (22)
0 SBCC Surcharge: (19)
(21) (23)
TOtal (Pages One &Two): Line(s) (11) +(12) +(13) +(14) +(15)+(16) +(17) +(18) +(19)+(20) +(21) +(22)+(23) = (24)
Bulletin #100 – February 19, 2002