06-105102! RECEIVED
OCT 0 5 zoos
�8C
CITY OF .
era ": ay. PEEMLWAY
ocawvlarrnsvecoPsxrrisRVress PT.
839? MW.UIVaXiWW FOBOX -971j, 16 APPLICATION
FBDBRAL WAY; WA• 94069 -9y1d ,
969.83"60r• PAX 26949w 2609
1(lW�tl.divnA!i:dernhiiay.mm .
- an
will not be
�13i,b
-0ZA',-j�
SF MF CO ME EL PL DE EN FP
SITE ADDRESS l �l0 �9 s : �% 2`�j s r� L SUITE /UNIT # do <U
ASSESSOR'$ TAX /PARCEL #1 S oil '7 '5-- O o .
— -- -- /-- — —• — — LOT SIZE (q, 7
LEGAL DESCRIPTION (e.g. Acme Estates, Lot
E�CY. ►L. i ✓ n S S� b) Gi f
r
• GIl�W�kPePol��hll�+l
TYPE-OF-PERMIT ❑ BUILDING . 13 PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Q FIRE PREVENI`ION SYSTEM
PROJECT DESCRIPTION (Pi nvide det ' ed description of work included on this ermit only)
h �f'rL .r[.Iic
e� 77'77tZ
PROJECT NAME (Name of Business or Owner Last Name) i"Ta `1C'3 T f
PROPERTY NAME�I PRIMARY PHONE
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
CITY, STATE ZIP .
Arruu+N t' NAME OFFICEPHONE
—e4e"4t -rill df 17
MAILING ADDRESS CITY, ST P CELL PHONE
CITY OF FED L'WAY BUSINESS LICENSE NUMBER EXPIRATION ATE FAX NUMBER
a o - 0 �r �_ : B
' CONTRACTORS REOLSTRATION NUMBER (copy of eard'rbqulrea with efeh apputatiWA EXPIRATION DATE
r} G' >r G .S 4_7 3 pu /U �3U 107
PANY LME
AP CANT N
OFFICE PHONE '
MAILING
AD ESS
� l� IJ14e-e S,
CITY, STATE ZIP
CELL PHONE"
RELATIOIISHI _TO PROJECT
❑ Architect p; Tenant a Agent,
/
❑ Other (Describe) (� !��
FAX NUMBER
(vU, ) .7 •� - �16. Ci
NA
'4`''� G' • e
PRIMARY PHONE
aG .�o'd' - 3 fir'.
S- MAILADDRESS
NAME
MAILING ADDRESS
CITY, STATE, ZIP.
PION .
E II15'I•ING' USE PROPOSED USE _
EXISTING ASSESSED /APPRAISED VALUE .7$ VALUE OF PROPOSED WORK PL Oa
ISPRINKLERED BUILDING? O YES a .N0 FIRE SUPPRESSION SYSTEM PROPOSED %REQUIRED? a YES a NO
Indicate number of each type of fixture to be installed or relocated as part
MECHAMCAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS
$BQS FANS
BOILERS FIREPLACE INSERTS
_. ,.- C0W2ZSSQRS , FURNACES
DUCTS 6,6 PIPE OUTLus
BATHTUBS (or7Lh /shower combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS _T
SUMPS
WASHING MACHINES
URINALS
LAVS maw.. swul
VACUUM BREAKERS
not include existing
GAS LOOS REFRIQ.SYSTEMS
HOODS po.arci WOODSTOVES
RANGES MISC (Describe)'
GAS WATER HEATERS
WATER CLOSETS (rodeo
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
MISC (Describe)
I certify under penalty of per that the information furnished by me is true and correct to the best of hty 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 (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made ,y dng person, including the undersigned, and filed against the City of Federal Wqj, but only where such claim
.arises out of the reliance of the city, including its o cers and employees, upon the, accuracy of the information supplied to the city as apart of
this application.
NAME /TITLE
,% DATE
(S star
(Title)
RELATIONSHIP TO PROJECT j Owner D Agent ontractor O Architect [] Other
N.
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL
IU MIDENTIAL SERVICE
❑ Single Family Square Feet
(First 1300 ft2- $107.50; Each add'n 500 ft' - $34.50)
❑ Detached outbuilding or garage
. (Inspected with service) $45.50
❑ Detached outbuilding or garage
(Inspected separately) $71.50
NEW MULTIFAMILY•
(three units or more)
CommerciaWndustrial Service or Feeder Ampacity
Service
Feeder
❑ Up to 200 amp
$117.00
$ 34.50
13 201 - 400 amp
145:00
71.50
13 401 - 600 amp
198.50
99.00
Q 601 - 800 amp
254.00
136400
❑ Over 800 amp
364.00
272.00
ALTERED SINCiLD /MULTI FAMILY
Service or Feeder
❑ 0 to 200 amp $ 89.50
❑ 201 - 600 amp 145.00
❑ over 600 amp 218.50
❑ # of circuits to.be added /altered
-(1-4 circuits- $71.50; Add'n circuits $7.00 /ea)
❑ Mast or meter repair $53.50
MOBILE HOMES
❑ Service or feeder only $71.50
Q Service and feeder $117:00
MOBILE HOME/RV PARK
❑ # of service or feeders
(First service /feeder - $71.50; each add'n - $46.50)
❑ # of, circuits to be added/ altered
(1 -5 circuits $91.50; Add'n circuits, $7.00 /ea)
COMMERCIAL INDUSTRIAL PLAN REVIEW
$91.50 plus-35% of Permit Fee
❑ Service - 1,000 amps or greater
❑ Medical /Educational /Institutional Facility
TEMPORARY SERVICE
Residenttal/Multi- Family
COMMERCIAL
CommerciaWndustrial Service or Feeder Ampacity
NNW COMMERCIAL /INDUS iRAL SERVICE.
$ 71.50
Service or Feeder Each Add'n
91.50
❑ 0 to. 100 amp $117.00 $ 71.50
107.50
❑ 101.6- 200 amp 145.00 91.50
145.00
13 201- 400 amp 272.00 107.50
157.00
❑ 401-600 amp 317.00 127.00
❑ 601- 800 amp 410.00 173.50
❑ 801 - 1000. amp 500.50 209.50
❑ Over 1000 amp, 546.00 291.00
❑ Over 600 volts surcharge $91.50
❑ Mast or meter.repair $99:00
ALTERED COMMERCIAL /INDUSTRIAL
Service or Feeders
❑ 0 to 200.amp $117.00
❑ 201- 600 amp 272.00
❑ 601- .1000 ainp 410.00
❑ over 1000 amp 456.50.
❑ # of, circuits to be added/ altered
(1 -5 circuits $91.50; Add'n circuits, $7.00 /ea)
COMMERCIAL INDUSTRIAL PLAN REVIEW
$91.50 plus-35% of Permit Fee
❑ Service - 1,000 amps or greater
❑ Medical /Educational /Institutional Facility
TEMPORARY SERVICE
Residenttal/Multi- Family
$63.00
CommerciaWndustrial 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 I
❑ # of Thermostats
st - $53.50; add''h- $16.50 /ea)
Low Voltage �O
Square Feet to be'served by system(s)
❑ Fire Alarm system
❑ security Alarm system
13 Voice Cabling
11 Data Cabling
(Per 8ystem(sj 1-12600 ft -- $63.00; .
Each add% 2500W-16.'50) * Per WAC 296. 4&920(5)(6)6 & iQ
❑ # of Signs
(First sign- $53.50; addh sign $25.00 /ea)
❑ Swimming pool /hot tub ................
(Includes additional circuit, if required)
❑ Yard Pole meter loops .....................
❑ Additional Plan review
(for modified submittals)
❑ Automation Fee on all Permits ..
$107.50
$71.50
$107.50 /hour
$5.00