05-105018t.. R
RECEIV _ S o I
� Federal wa'p PERMIT �1
COMMLNnY DEVELOPMENT SERVIC� EP 2 9 2005 SF MF - CO ME EL PL DE El
39525 D AVENUE SWA 9 • PD LLDIC 9713 ,�' LI CATI O N
FEDERAL WAY, X 53o 3 Y O F EE D E R
253.895.2607• AAX 25383
www,dyffffdemba%com BUILDING DEPT.
The foUawina is neauined information - an incomplete amUcation will not be accepted. Please print legibly (in 'veld or t
SITE ADDRESS � �� �� �(s7 • �r �G/f SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # - - ` - e 3 ,Q�� j� LOT SIZE (sfi
LEGAL ]DESCRIPTION (e.g. Acme Estates, Lot 1) �5�� /i ��4/' 9'
I PROJECT INFORMATION
TYPE OF PERMIT O BUILDING r PLUl1i =G ❑ MECHANICAL
❑ DEMOLITION -, 1,LECTRICAL ❑ ENGINEERING XFM PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description o. f work ftclLicled on this nerniit onlu)
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE •-
PROPERTY N / n ¢ PRIMARY PHONE
OWNER lo'3�>t'l �l�df? / 2zz k-e (
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
✓>�i^� a��c fa�� ,� C /dam L�� �` ��s"���6 "�' �t
MAILING AD/D•R�ESS CITY, SATE, ZIP CELL PHONE
CTTY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DA7 FAX NUMBER
62 42 - 1 D,22- y B L 4;1?-51
coN1RA4:TOR'S REGIS7PAATION NUMBER (copy of eud required with emh AppLoatlon) E 1 L1�+�0,/,a
CONTACT
LENDER
EXISTING USE
CO;N7p7 NAME ,0 ,r
APPLICANT NAME i �!
/OFFICE PHONE - n)
-
MAILING ADDRESS �r
CIIY, TE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
('
❑ Architect ❑ Tenant ent ❑ Other
(Describe)
EXISTING ASSESSED/APPRAISED VALUE
PROPOSED USE L i(/l G e°'C r,eaf
VALUE OF PROPOSED WORK $ "do
SPRIIHHI.ERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ BIGBLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 13 LAKEHAVEN o HIGHLIKE ❑ PRIVATE (SEPTIC) }
PROJECT FLOOR AREAS
ESISTING
DECK (COVERED')
NUMBER OF FLOORS — --
••NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of jixture to be installed or relocated as part of this project. Do not include existing f fixtures to remaut.
UM,
fechanicai Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS Im7bb /SOwerCombo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS ftu000m S nW
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS t
RANGES
GAS WATER HEATERS
WATER CLOSETS nbnlet)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy under penalty of perjury that the u formation 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 agree to hold
harmless the [pity of F*deral Way as to any claim (including costs, expenses, and attameys' fees incurred in the investigation and defense of
such clainj, which may be made by any person, Including the undersigned, and filed {led against the City 4f Federal Way, but only where such claim
arlses out of the reliance of the city, including its ooicers and employees, upon the accuracy of the ir)jormation supplied to the city as a part of
this application.
NAME /TITLE DATE
(Signature) ruffle) !
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin #100 - January 7, 2005 Page 2 of 4 MandoutsTennit Application
k
1
RESIDENTIAL
COMMERCIAL
NEW RESIDENTLAr SERVICE
NEW COMMERCIAL /INDUSTRIAL SERVICE
❑ Single Family Square Feet
-500
Service or Feeder Each Add'n
( First 1300 ft2- $104.50; Each add'n ,ft- - $33.50)
❑ Detached outbuilding or
❑ 0 to 100 amp $113.50 $ 69.50
garage
(Inspected with service) $44.00
❑ 101 - 200 amp 141.00 89.00
❑ 201 - 400 amp 264.50
❑ Detached outbuilding or garage
104.00
(Inspected separately) $69.50
❑ 401 - 600 amp 308.00 123.50
❑ 601 - 800 amp 398.50
NEW MULTI FAMII.Y (three units or more)
168.50
❑ 801 - 1000 amp 486.50 203.50
❑ Over 1000 amp 530.50
Service Feeder
283.00
❑ Up to 200 amp $113.50 $ 33.50
❑ Over 600 volts surcharge $89.00
❑ 201 - 400 amp 141.00 69.50
❑ 401
❑ Mast or meter repair $96.00
- 600 amp 193.00 96.00
❑ 601 - 800 amp 247.00 132.00
ALTERED COMMERCIAL /INDUSTRIAL
❑ Over 800 amp 353.50 264.50
Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE /MULTI FAMILY
❑ 201 - 600 amp 264.50
Service or Feeder
❑ 601 - 1000 amp 398.50
❑ 0 to 200 amp $ 87.00
❑ over 1000 amp 443.50
❑ 201 - 600 amp 141.00
❑
❑ over 600 amp 212.50
# of circuits to be added /altered
(1 -5 circuits - $69.00; Add'n circuits. $7.00 /ea)
❑ # of circuits to be added /altered
COMMERCIAL /INDUSTRIAL PLAN REVIEW
(1-4 circuits - $69.50; Add'n circuits $7.00 /ea)
$89.00 plus 3596 of Permit Fee
❑ Mast or meter repair $52.00
❑ Service - 1,000 amps or greater
❑ Medical /Educational /Institutional Facility
MORKE HOMES
❑ Service or feeder only $69.50
❑ Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOUR !RV PARK
❑ # of service or feeders
Residentialftrlti Famii(y $61.00
(First service /feeder469.50; each add'n -$45.00)
Commerrialfthdustrial Service or Feeder Anymcity
❑ 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
�(First - $52.00; add' n - $16.00 /ea) J��g�/
ow voltage 6 '-�'C�
❑ # of signs
(First sign - $52.00; add'n sign $24.50 /ea)
Square Feet to be served stem
by sy (
❑ pod/hot tub .............. .. $87.00
(includes
Fire Alarm system
additional circuit, if required)
❑ Security Alarm System
❑ Yard Pole meter loops ..................... $104.50
❑ Voice Cabling
❑ Additional Plan Review $104.50 /hour
13 Data Cabling
(for modified submittals)
❑
❑ Automation Fee on all Permits .. $5.00
(Per System(.) 1- 2500 ft2- $61.00;
Each add'n 2500 ft2- 16.00) • Per was 29646.910(5)(b)a & W
Bulletin #100 - January 7, 2005 Page 3 of 4
MandoutsTermit Application