08-101771Fedmlfty PERMIT
RECE ED
C,"wMff ME P SF MF CO ME I�P PL DE EN FP
3334d dMAYBNUBSWA 9W O9718 dAPR r 5 o 'PLICATION
RBDBRAL WAY, WA9d069971d
4SdJdS9607- RA1I45Jd95•Y609
ww"asaftsihmim CITY OF FEDERAL WAY
The following is required infor*86on -an incomplete application will not be accepted. Please print legibly (in inki or type.
SITE ADDRESS 27'k3Ca {'1lLe,6 S. r- r &,raj M 966- SUITE /UNTr•
ASSESSOR'S TAX /PARCEL ti — — — — — — — — — LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
PROJECT INCORIJATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FDZE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this DermA onlul
PROJECT NAME (Name Of Business or Owner Last Namel
PROPERTY
OWNER
l' icer k � I' P0kr+V ► ere
PRMARY PHONE
(.�a ► ,?Nl -a
OFFICE PHONE
(153)Sq
MAIUNO ADDRE93
CrrY, AT , ZIP
E-MAILADDRESS
CrrY STATE, 21P
Lakes T s Ula• ? 3` 1
('7796 Des M m
UiR
CITY OF FEDERAL WAY BUSINB.9S UCBNSB NUMBER
CONTRACTOR
✓0�
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
�� lec�r�L
`-n
CANT N,B
/inn
OFFICE PHONE
(153)Sq
- �ll�ly
MAIUNO ADDRESS
a i o J6401 g..
CIT'Y 9TATB, Z�
[,a Ta U/a 49"34!
CrrY STATE, 21P
Lakes T s Ula• ? 3` 1
CEU, PHONE
1S3
- g7P_
CITY OF FEDERAL WAY BUSINB.9S UCBNSB NUMBER
RATION DATE
RAIC NUMBER
(;63). 8
- z/y
o XTRACroati RBOUTRATIOR NSMBBR
fl 9 L S * 03 D
rXPERATION DATE
x-09
E -MAIL ADDRESS
0eeleC+r4At:6 7at
COMPANY NAMB
iJ a. E E f
`-n
NAMB
nn T
OFFICE PHONE
X53 $4! - 111 qq
MAWNO ADD1�� th
21220 `b�
£,
CIT'Y 9TATB, Z�
[,a Ta U/a 49"34!
CELL PHONE
�S3 bdb - �L8'7�
RELATIONSHIP TO PROJECT
RAX NUNHER
0 Architect 0 Tenant
0 Agent dotiler
$,0?6 - P/y66
NAME
PRIMARY PHONE
B•MAIL ADDRESS
25,316 Ob - 0 9 -7
Dteiecfr+�(�7�t��a
NAME
Per RCW 19.27,095:
Lender WOreWadon is required V pr4hct aduls aw"ds $5ti000
MAIUNO ADDRESS
CIPY, STATE, ZW
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUES VALUE OF PROPOSED WORK $
SPRDNIMERED BUILDING? n YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? o YES O NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE (WELL)
SEWER SERVICE PROVIDER 13 LAKEHAVEN 0 HIOHLINE 0 PRIVATE ISEPTICI
to).
:W*7
rdub%
AREA DESCRIPTION
BASEMENT
EXISTING
8 . FT.
PROPOSED
S . FT.
TOTAL
So. FT.
FIRST
PANS
GAS WATER HEATERS
MISC (Deacribel
SECOND
FUMPIACE INSERTS
HOODS ,q
THIRD
FURNACES
RANGES '
a NO
ADDITIONAL FLOORS (DESCRIBE)
GAS LAO SETS
REFRIG. SYSTEMS
UP /SEPA /13117
DECK (❑ COVERED OR ❑ UNCOVERED?)
a NO
PLATTED LOT?
a YES o NO
GARAGE ❑ CARPORT ❑
LAVS Is.* —=amq
URINALS
M1SC (Describe)
NUMBER OF FLOORS
rDiO'w
"'
10razzruma
TWALreoroemsr
,ores
"NEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLINO PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include exis '
tmgJudures to remain.
Value of Medumical Work $ (A OF BID OR ES7UMTE MUST BE INCLUDED WITHAPPLICATIONf
AIR HANDLING UNITS
EVAPORATIVE COOLERS
OAS PIPE OUTLETS
WOODSTOVE9
BBQS
PANS
GAS WATER HEATERS
MISC (Deacribel
BOILERS
FUMPIACE INSERTS
HOODS ,q
COMPRESSORS
FURNACES
RANGES '
a NO
DUCTS.
GAS LAO SETS
REFRIG. SYSTEMS
UP /SEPA /13117
G
a NO
PLATTED LOT?
a YES o NO
BATHTUBS
LAVS Is.* —=amq
URINALS
M1SC (Describe)
DISHWASHERS
RAINWATER SY3T
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS harp
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES,
HOSE BIBBS
SUMPS
I onij/y under penalig of perjury that I am the property owner or authertved 'agent of the property owner. I corto that to the bast of we
knowle446 the b{fermatton submitted in support of this permit application to true and correct. r eertQk that r will cei y with all appaeable
CUM of ltiaeral Way regulations pertaining to the work authortaaa by the issuance q f a permiL I understand that the issuance of this permit
does not remove the owner's responsibittty for compliance with Idea; state, or federal laws regulating construction or environmental laws.
I further agree to hold harmless the City of roderal Way as to any claim (iacludtng costa, expenses, and attorneys' fees incurred In the
investigation and defense of each clamp, which mury be made by any person, including the undersigned, and flied against the silt. but onto
when such claim arises out of the reliance of the WAY, including its ofJiears and employees, upon the accuracy of the 1rVormanon supplied to
the city as a part of 9&—applicaHon_
SIGNATURE'
ZI-15 -o F
a NEW o ADDITION
o ALTERATION
D REPAIR D, TENANT IMPROVEMENT
BUMDING SHBLL ONLY?
a YES a NO
BASIC PLAN?
o. YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a TES
a NO
NEW ADDRESS REQUIRED?
D YES a NO
UP /SEPA /13117
D YES
a NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED?
o YE8
o NO
tsmletm iF f uu — January 1, mum Page 2 of 4 MandoutsTennit Application
RESIDENTIAL
❑ Single Family Square Feet
(First 1300 fn- $115.50; Bach addh 500 It2 - $37.00)
❑ Detached outbuilding or garage
(Inspected with service) $48.50
❑ Detached outbuilding or garage
(Inspected separately) $76.50
NEW MULTI -F urr
v (three units or more)
$ 76.50
Seruke
Feeder
❑ Up to 200 amp
$125.50
$ 37.00
❑ 201 - 400 amp
155.50
76.50
13 401 - 600 amp
212.50
106.00
❑ '601 - 800 amp
272.00
145.50
❑ Over 800 amp
389:50
291.00
ALTERED SINGLE
/ MULTI FMr► y
$ 76.50
Service or Feeder
❑ 0 to 200 amp
$ 96.00
❑ 201 - 600 amp
155.50
❑ over 600 amp
234.00
❑ # of circuits to be added /altered
(1-4 circuits - $76.50; Add% circuits $7.50 /ea)
❑ Mast or meter repair $57.50
'fAMMACTURED HOMES
❑ Service or feeder only $76.50
❑ Service and feeder $125.50
MOBILE HOME /RV P M
❑ # of service or feeders
(First service /feeder,476.50; each addh 450.001
COMMERCIAL
KIM COM30MIAL/WDUBTRIAL ArlQOrAR
SeruloeorFeeder RadtAddh
❑ 0 to 100 amp $125.50 $ 76.50
❑ 101- 200 amp 155.50 98.00
❑ 201 - 400 amp 291.00 115.00
❑ 401 - 600 amp 339.50 136.00
❑ 601- 800 amp 439.00 186.00
❑ 801 - 1000 amp 536.50 224.50
❑ Over 1000 amp 584.50 311.50
❑ Over 600 volts surcharge $98.00
❑ Mast or meter repair $106.00
ALTERED COMAIRUd aIINDLATRIAL
Sen4ce or Feeders
❑ 0 to 200 amp $125.50
❑ 201 - 600 amp 291.00
❑ 601 - 1000 amp 439.00
❑ over 1000 amp 489.00
❑ # of circuits to be added/ altered
(15 circuits - $98.00; Addh circuits, $7.50 /ea)
COMMERCr_ar. nuDUST rAr Dr AN 22r TrM r
$98.00 plus 350/a of Permit Fee
❑ Service - 1,000 amps or greater
❑ Medical /Educational /Inatitutional Facility
TEMPORARY SERVICE
Residentia(/Muld- ramfly $67.50
ConnnsrefaWndustrial Berofos orleederAnyxtefty
❑ 0 -100 amps
$ 76.50
❑ 101- 200 amps
98.00
❑ 201 -400 amps
115.00
❑ 401 - 600 amps
155.50
❑ over 600 amps
168.00
MISCELLANEOUS SERVICE /EQUIPMENT
❑ # of Thermostats
(19rat - $57.50; addln- $17.50 /e4
la Low Voltage p
Square Feet to be served by eystem(s) 7
IF Fire Alarm System
E3 security Alarm system
O voice Cabling
0 Data Cabling
1.1 2500 Q+-$67.50.
Each addh 2500 W - $17.50) •Per WAC296- r6970(gbM A W
❑ # of Signs
(First sign - $57.50; add n eta $27.00 /e4
❑ Swimming pool /hot tub ................
(Includes additional circuit, if required)
❑ Yard Pole meter loops .....................
0 Additional Plan Review
(for modified submittals)
❑ Automation Fee on all Permits ..
$115.00
$76.50
$115.00 /hour
$5.50
°°'r ,IWO Page 3 of 4 klAandoutsWemtit Application