06-101422TUL-11-2006 16:11 P.02
W;F JED
ssuvr 2 PERMIT •,RMIT - - •">•r.; -,•.:. �� 1 2 006 SF MF CO ME PE.. DE EN FP
ro eaX
YXA 96064 97Je p LI C ATI O N °
7�PNcss��ssasav F FEDERAL1 1 ----- -
Y O DEFT -
•BUILDING
" tried infarmatton — an inco fete a Zicution wZZZ not be accepted- Please rjn* !6 in Lnkj or
p
„y sUITE/uxEr
`s n :y+l3R'S 7`AX/PARCEL # LOT SIZE (fI
I t]?ESCRLpTION (e.g. Acme Estates, Lot I )
'ir,• Y.(^, µmd,srpa�aapq�sjarlenyoy,apddsaofydan) -
'`
PERMIT Cl BUILDING ❑ PLULMIx(3 ❑ MFr_rxerrr0AL -
t >
❑ DEMOLITION XELMTRICAL ❑ ENGINEERING' ❑ FIRE PREVENTION SmTP-M
? �,;:;CT;DBSC'RIPTiON (Proufcia �[�et—ailed dfesori�ption of work included on jhi,�yermu on1u1
r�•;'�1Fn!i YidJl:.� f�� .'.1' �'�Twl.!.. ;:��_.: ,.}, -•'+iA
•`�+{NAME (Name of Business or Owner 14;t Name)
I'G i1.1
0 AE
MA14 Q AC
qi4'. _ � (TlY pFPt
OUNTRACT
ArftkiANT
5h
.
im
CITY, STATE, =P
A�PIICANT NAl$E � ,
CITY, STATE, ZAP
"'iti7[P1xATION DA7E ' •=
1t$rRATION NUMBER a n�
00c977
00I NAME
win
JWUCANT NAME
OMCB PHONE
, -.
MAR1H ADDR&S9
C nY,STAM,zLPAEa
`
TIONSHIP M PRQIECC
FAX NUMHFlt
❑ Architect q T=' SLnt ❑ Agent 0 Other (De- ca be)
-9,3e s >� A�fl�l: ,
irk'
'I ^ 71ICF xf
_.
PROPOSED U=
ASSF-S=/APPRAISED VALUE ¢
VALTIE ol= PROPOSED W OI2Fi ¢
;,.., .. t4T BIIILDIIiC><? ❑YES 0 NO
FIRE SUPRFMSXON SYSTEM PROPOSFA/RRQUZRED? p yE* ❑ Ii0
_' ;: ;
', R.SERVICE PRDVIDYrR ❑ LAIMIIAVF_N
❑ HIGITLXNE ❑ rACQ�rA ❑PRIVATE fV{TEPT.1
JUL-11-2006 16:11 P.03
AREA DESCRIPTION
E]�L,S3TIKG
PR 40SED
TOTAL
S . FT.
SO. FT.
50, FT.
d'
R.
1, `
r. AL FLOORS (DESCRIBE)
CAPPORT o
N
a' A-
b. OF FWORS
=lXMO TROrazw
TOTAL
OF BEDROOMS
%ate number of each type of fi dure to be installed or relocated as port of this project Do not include eusUiigfuiures to remain.
•c,
-' BtJ]antLlal Work
{y"
.
} + " _ , A[It HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REBRIQ. SYSTEMS
—� BBQS
FANS
HOODS WOODSTOVES
FWPLACE INSERTS
RANCIES ' ti . MIBC (Destsibe) .
'� `:1`t
���, • :'• -', . .'DpA�IPR85.9�I2s •- ...
_- p'ORNACES
....
-, c. t ;i ,• DUCC9
GAS PIPE OUTLETS
BAT#TUBs
SHOWERS
WATER CLOSE73 p" VIM (Describc)
�•; DisgWASHERS
SINKS
DRINKINQ FOUNTAINS ,
OUTi.E'I'3
SUMPS
RAINWATER SYST
WA 11INQ MACHINES
URINALS
HOSE BIBBS
VACUUM BRk .FRS .
EI ECTRIQ WATER HE 4TER8
��rPe7�Ir Of Pe�fl. that the W�ormatian furnished by me is but and wirect to the best m� that t
• •' gl nor Ir+ro dga end �tertlrer,
it,
'aupiori�tits owner of the abays premises to'perfoTm the work for which the perrmt application is made. 1 frvtlur ague to hold
thCi Fsd*ral W as to an claim inciudin coals enscs and atto i0 ees i ek. �Ii � a9 y i 9 r�n � rna�r f ncryr d In the innsatigation and dgfene of
iatipJ,'rohich maybs mads by any person, tnciud ng the undersigned, andfiled ag&lnse the City ofFedcru W ay,•but onW where such claim
'S;id Of the retidrrce of thm city_ incLudi—r its orRe—s and — 1-1— ,,,,,... tl,. ♦r.. .al...� ..,...r ..f
JUL-11-2006 16:11
P. 04
RESIDENTIAL
amily, Squaro Peet
-*i07,50; FAch addh 500 W - $34-50)
outbuilding or garage
- cted with service)
yid outbuilding or garage
ect ed separately)
$71.50
(three �1Dits or more)
Feeder
pp"Qmp 117,00
$34.50
amp 145-.00
71.50
. . . . . . . . . .
SpO al*p 198.50
99,00
'T, 254.00
136.00
viap 364.00
272.00
lervine or Feeder
$89,50
81n)p
V, 1, Ug ` SO
U OMP 145.00
.1:41of circuits to be added/ altered
4rycirculta $7_00jeft)
cieCWt547l,5&. Ad
ut Aflawor:, ter
'z
3r_r,6zjy,$71'150
of scrvje6 dr fiedera
M "
rst j/0i&d&r471-S0-. each aAdn 446,501
COMMERCIAL
XnW Corn =Q1_AL/Z_DUGTFQk ff!NE
Service Or Fcad� Lash Add n
❑ 6 to , 100 amp $117.00 $1, 71-SO
❑ 10 1,7- 200 amp 145-00 .91.50
❑ 201.- 400 amp 272.00 107.50
❑ 401 - 600 amp 317.00 127.00
C1 6 01 - 800 amp 410.00 173,50
❑ 801 - 1000,4mp .500.50 209.50
cl over iood,wap 546.00 291.00
n' Over 600 volts surchDt9c
❑ Must or meter rep* $99.00 10
ALT COMM . CTALIVWOIZ�
Sanico ot Feadets
C). 0 to 200-iunp. $117.00,
0 201,660 amp 272.04"
Ll 601 -.1600 ii-p 4,10.00
11 Over, 1000 amp 456.80
of circuits to be Wqd1dterdd
$91.S0. AUAcfildiiko, *710/w4
co MRCM/ u
ULR -
$91.60 plus 35ya of Perblit Fed
❑ Service - 1.000 amps or,greater,;..
cl medical/Educadonalliu3titutional FacMTY
TEMPORARY 01;RVICE
Re3icUntlaMularamily
$63.00
commercjaWnau4*jar.seruNa or J*ed- A-Rcm1V
U o - lod amps
$ 71.50
C3 10,1 - 200 ampEi
L3 201'- 400 aippp
107,50'
401 - 600 auipa'
over 600. nImp's
MISC E I LLANDOU . S SERVICE/EQUIPMENT
. JI
Ji
E
of Slgns
453.50; �Ldd)a-$16,50/00
rst .56; udd�a*p $2,5.0wen)
(Fir alga-$53
E3 SW121l=Jug pool/hot tub .................
$10-7.60
•
Feet to be'Wv6d by sptc&(s)
7
(Includes additional -h=lt if requi-d)
❑ Yard Polo =tff loopa
Ll ftcAlsrm Syatm
.............
&=U24tymm system
❑ Additional Plan Review
$107.50/hour
��V
�'j N Cabling
is (for modified submittals)
JUM Ciblirig
tl -'A�utom:&fjojx Fee on Ru Permits,
Mao
0 J;E16.50) A 29
TOTAL P.04
Auk
My or <'
Federal 11Vay
COMMUNQYDEVELOPMENT88RWC
33325 8TM AVENUE SOUTH • PO BOX
FEDERAL WAY, RA 98063-9718
253-835-2607• FAX 253-835-2609
EiJim�j d!14iI 1 rnm
The_followina is rw"
6;E PERMIT
PPLICATION
_ _FEDERAL WAY
SITE ADDRESS _G-S'L f55 P/AC&7S.
wtll not be
-L- / L! qj�
SF MF CO ME EL PL DE EN .6,
�'"63
/ 2
led. Please print legibi'mriR ink) or tune.
ASSESSOR'S TAR/PARCEL # � -:5- -z-, -�- ! i C) - 0— - � LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Ir x � f � J
Gt�ssepayofcPuaefa IuWffW &gWdcear dmo
PROJECT•• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL �
❑ DEMOLITION [I ELECTRICAL ❑ ENGINEERING YFO#&E PREVENTION SYSTEM
PROTECT DESCRIPTION (Provide detailed
s R 1 j _
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE INFORMATION
PROPERTY NAtKE PRIMARY PxoNS
OWNER ...,, G�'i (zs> )935
CONTRACTOR
APPLICANT
CONTACT
LENDER
eD. Bbm 23(ac(
&Iz-
MAILING IIDDRESii Cl9Y. STATE. ZIP CFLL PHONE
❑ Architect ❑ Tenant ❑ Agent
Em
PerRM 19.27.095: Lender information is
required (fprofert value exceeds $5,000
FAX NUMI
Ppf ARY PHORB EMAIL AL
c
NAMV
CITY, STATE, ZIP PHONE
(
3S3 - L(
EXISTING USE &Prt-fI%L PROPOSED USE -54 --
EXISTING ASSESSED/APPRAISED�ALUE $ VALUE OF PROPOSED WORK $
SPRiNKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ PRIVATE
Indicate number of each type of jbdLLre to be installed or rebcated as part of this project Do not inckute pdstimfMAres to remain.
1/alue of Mechanical Work $.
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REFRIG. SYSTEMS
BBBS
FANS
HOODS(com ere!g WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES NUSC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
BATHTUBS (-Mib/Sho C—bo) SHOWERS WATER CLOSETS atuery MISC (Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS lrsu a�,a S»k;) VACUUM BREAKERS ELECTRIC WATER HEATERS
I certVy under penalty oj'perjury that the inifarmation furnished by me is true and correct to the bell of my iaiawledge, and further, that I
am authariseed by the owner of the above premises to perform the work for which the ,permit application is made, I further agree to hold
harmless the City of Federal Way as to any claim (including cysts, etpenses, and attorneys' fees incurred in the investigation and defense rf
such ciaW, evhich may be muds by an person, including the Undersigned, andfiled against the City ofi'ederal Way, but only where such claim
arises out rf the reliance of the ci ,.t lading its officers and employees, upon the accuracy of the i ormation supplied to the city as a part of
this application.
NAME/TITLE DATE
[$kgiltilurrl (Title) -
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent I3 6"tractor ❑ Architect '3 Other
FOR, OFFICE USE ONLY
❑ NEW o ADDITION ❑ ALTERATION 0 REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES 0 NO BASIC PLAN? ❑ YES ❑ NO
ZONING DESIGNATION CHANGE OF USE? ❑ YES 0 NO
NEW ADDRESS REg[f[IZED? ❑ YES ❑ NO UP/SEPA/SU? 0 YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO DEMO PERMIT R.E9UIRED? ❑ YES ❑ NO
Bulletin #100 — January 1, 2006 Page 2 of 4 klHandouts\Permit Application