06-101214r
t1rY OF ® RECEI&
Federal Wa t�
�' MAR 14 2006 PERMIT E RM IT SF MF CO ME EL PL DE E
COMMUNITY DEVELOPMENT SERVICES
33325 AVENUE SOUTH • BOX 9718 „ �I,I CATI O N
FEDERAL WAY, WA 98063 63 -9718^ [D
253 - 835 -2607• FAX 253 - 835- 2660TY O F FE D
www cituo(federatway cam BUILDING DEPT.
The followi n is re uired in ormntion - an incom lete a lication will not be acce ted. Please print le ibl (in ink) or
PROPERTY 1 INFORMATION
J
SITE ADDRESS i� f i"� J7i� p �-! SUITE /UNIT # / f L
ASSESSOR'S TAX /PARCEL # V �/- /LOT SIZE tsf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) /—C'r �jr L�/ st�l -�y ci f it l /31 A .
(Att -h -p—te page j 1-gthy LV d,- ,iptf.W
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING [FIRE PREVENTION SYSTEM
PRO�JE�CT' D /ESC'PT�N (Prouidq detail /ed d /escr' do /n of work included on this permit oniul
PROJECT NAME (Name of Business or Owner Last Name) /`"f'7Av' J •'1/•4 Y
PEOPLE i • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
XISTING USE
PHONE PRIMARY
CITY, STATE, ZIP
••-
COMPANY NAME
APP ANT NAMED L
OFFICE PHONE y
CITY, STATE, ZIP
�J,�i���
MAILING ADDRESS �/�1 �
CITY. SST /ATE, Z�1n'. ��` L� tl
`ELL PHONE -
PA // C
l I
CITY OF FEDIMRAL WAY BUSINESS LICENSE NUMBER
rcis'l7- -B
EXPIRATION DATE
/�-//3 /�
FAX NUMBER
�)`9,? -3�r`1
-I4- _v2-
L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
EXPIRATION DATE
-PA e-7 r-- Yy73Pu
COMPANY rJAME
APPJ�CANT N
OFFICE PHONE
CITY, STATE, ZIP
�J,�i���
MAILING ADDRESS
CITY, STATE ZIP
Ste
CELL PHONE
-
P. ,�
RELATIONSHIP TO PROJECT . �^
❑ Architect ❑ Tenant El Agent UkOther (Describe.) �^+ f t^�
FAX NUMBER
066) W4 - 1?16U
NA'* / � C PRIMARY PHONE - E N C" el SS
"r, ` Z
Per RCW 19.27,098: Lender information is
required if project value exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
/P/HONE
l ) -
KISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK $ , j SU r Inc-,
IRINKLERED BUILDING? `& YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
1TER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
WER SERVICE PROVIDER ❑ LAKEHAVEN 11 HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOTAL EX[ STING SF
TOTAL PROPOSED SF
TOTAL SP
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not
MECHANICAL
Value of Mechanical Work $,
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tuh /shwe, combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAYS (Bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (Commemiao
RANGES
GAS WATER HEATERS
WATER CLOSETS (Touet) _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 agree to hold
harmless the City of Federal Way as to any claim lincluding 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 of Federal Way, but only where 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 of
this application. n n 2
NAME /TITLE VLJ�F>��\�� J�/c �J /LN�ii DATE 3 — J-6'C:�
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑Architect El Other
letin #100 —January 1, 2006 Page 2 of 4 k\Handouts\Permit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL
COMMERCIAL
NEW COMMERCIAL /INDUSTRIAL SERVICE
NEW RESIDENTIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
❑ 0 to 100 amp $117.00 $ 71.50
(First 1300 ft2- $107.50; Each add'n 500 ft2 - $34.50)
❑ 101 - 200 amp 145.00 91.50
❑ Detached outbuilding or garage
(Inspected with service) $45.50
❑ 201 - 400 amp 272.00 107.50
❑ Detached outbuilding or garage
❑ 401 - 600 amp 317.00 1.27.00
(Inspected separately) $71.50
❑ 601 - 800 amp 410.00 173.50
❑ 801 - 1000 amp 500.50 209.50
NEW MULTI - FAMILY (three units or more)
❑ Over 1000 amp 546.00 291.00
Service Feeder
❑ Up to 200 amp $117.00 $ 34.50
❑ Over 600 volts surcharge $91.50
❑ 201 400 amp 145.00 71.50
❑ Mast or meter repair $99.00
❑ 401 600 amp 198.50 99.00
ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 - 800 amp 254.00 136.00
❑ Over 800 amp 364.00 272.00
Service or Feeders
❑ 0 to 200 amp $117.00
ALTERED SINGLE /MULTI FAMILY
❑ 201 - 600 amp 272.00
❑ 601 - 1000 amp 410.00
Service or Feeder
❑ over 1000 amp 456.50
❑ 0 to 200 amp $ 89.50
❑ 201 - 600 amp 145.00
❑ # of circuits to be added /altered
❑ over 600 amp 218.50
(1 -5 circuits - $91.50; Add'n circuits, $7.00 /ea)
❑ be
COMMERCIAL /INDUSTRIAL PLAN REVIEW
# of circuits to added /altered
$91.50 plus 35% of Permit Fee
(1 -4 circuits - $71.50; Add'n circuits $7.00 /ea)
❑ Service - 1,000 amps or greater
❑ Mast or meter repair $53.50
❑ Medical /Educational /Institutional Facility
MOBILE HOMES
❑ Service or feeder only $71.50
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK
Residential/Multi- Family $63.00
❑ # of service or feeders
(First service /feeder - $71.50; each add'n - $46.50)
Commercial/Industrial Service or Feeder Ampacity
❑ 0 - 100 amps $ 71.50
❑ 101 - 200 amps 91.50
❑ 201 - 400 amps 107.50
❑ 401 - 600 amps 145.00
❑ over 600 amps 157.00
MISCELLANEOUS SERVICE /EQUIPMENT
❑ # of Thermostats
❑ # of Signs
(First - $53.50; add'n - $16.50 /ea)
(First sign - $53.50; add'n sign $25.00 /ea)
IJ Low Voltage �yy
be by C_ ��
❑ Swimming pool /hot tub ................ $107.50
(Includes additional circuit, if required)
Square Feet to served system(s)_ !
�'K Fire Alarm System f
❑ Yard Pole meter loops ..................... $71.50
❑ Security Alarm System
❑ Additional Plan Review $107.50 /hour
❑ Voice Cabling
(for modified submittals)
❑ Data Cabling
❑ Automation Fee on all Permits .. $5.00
(Per System(s) 1- 2500 ft2- $63.00;
Each add'n 2500 ft2 - 16.50) *Per WAC 296- 46- 9100)(b)(i a, ii)
Bulletin #100 -January 1, 2006
Page 3 of 4
k \Handouts \Permit Application