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05-101353 prof • • - Lo 1 3 5 3 Federalli( EivED PERMIT SFMFCOMEELPLDEE0 COMMUNITY DEVELOPMENT SERVICES 33325 8TH AVENUE SOUTH•PO BOX 9718 2005 APPLICATION FEDERAL WAY, X 9{t A]i18 / / 253-835.2607•FAX 25 09 www.tit yolfederalwa u.com The ollotf .•YiPA;; ;t 3 .:.,,TWA•Lion-an Inco •lete • ••lication will not be acce•ted. Please •rint le,ibl in i or • . ` • PROPERTY INFORMATION SITE ADDRESS 4/-5-O .S W C lei N1p ( s b/z J C SUITE/UNIT# ASSESSOR'S TAX/PARCEL# - LOT SIZE(sj7 LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) (Attach separate page for lengthy legal description) ■ PROJECT INFORMATION TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ,(FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) r (:� .x1 41 C t #r -)--sZ u PROJECT NAME(Name of Business or Owner Last Name) T' e N ,Z L L)A t._ A(3 ©l.t)4 . L S 17 l G L 45,.. '1.—ec • PEOPLE INFORMATION `/ PROPERTY NAME /� /� ( p /,J,0 PRIMARY PHONE OWNER MAILIN�� <�Vl 1 �!/�y l/t I e l L1 J\�lly ( ) - - CONTRACTOR COMPANY NAME ' APPLICANT NAME OFFICE PHONE A b°7--Se c..0 Z.:��j S8 Ru.rL 6. L'• B�Ct,, (IiZ3-) 4%bz --33,s-‘ MAILING ADDRESS CITY,STATE,ZIP CELL PHONE I l8'zy n), �2i;aIL P/c- LU.4c. B 4-te[.L La) 42/e01/ ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBS E TION DATE FAX NUMBER - - - B L LS) '4"//6—- 4i44/ CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE p Qc''irS Sir 0a z d 5 / / APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE e-SI 1p�S�2,��=!u � �Sl R�!zc C . C. Ze (lJZjD'L -3: 5(0 MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE I )R`Zti r+.) <:11p�A , PKt„�? j .8b *tei-L. c.,. � <kb11 ( ) - RELATIONSHIP TO PROJECT ". FAX NUMBER ❑ Architect ❑Tenant ❑Agent ❑ Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS ..e : a' . Z t2,,, (iii 4•0 z - 33 s,� .y b e acoo`-.4-bvY1 LENDER x Y NAME MAILING ADDRESS CITY,STATE,ZIP ■ DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES CI NO WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑TACOMA ❑PRIVATE(WELL) 41/3 SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑IISGHLINE ❑PRIVATE(SEPTIC) PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. _• BASEMENT -FIRST SECOND THIRD FOURTH ADDITIONAL FLOORS(DESCRIBE) -DECK(COVERED?) GARAGE ❑ CARPORT❑ ERISTING PROPOSED TOTAL TOTAL LNIS7Df6 SF -.,k ,,TOTAL PROPOSED SF '� TOTAL SF NUMBER OF FLOORS **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. 1 MECFIANICAL Value of Mechanical Work $ ! AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS Icommen al) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS GAS PIPE OUTLETS i i PLUMBING BATHTUBS(or Tub/show,combo) - SHOWERS WATER CLOSETS(FoI1 MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST I WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the{reformation 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(including costs, expenses, and attorneys'fees incurred{n 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{reformation supplied to the city as a part of this application. NAME/TITLE c,../ DATE _3--Z �%'�� (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent )ontractor ❑Architect ❑ Other -,,,,-,„---,:----,----„-...-,iii-*--.,,,i1 -,_ , .':._ , . ... ., i )DI'ON v AL,r,,,,,,, ._ATION ti REPAIR ? TENANT IMPRO'�EMENT'•' Ns i e 1 e 1 HELL( (L ? - , NNNO ' 4 BASIC PLAN? N��x:27, ,ci YES ONO !G ESIGNAl ON `` ;,,' CHANGE1OFFUSE'? ❑.YES O '' a T RESS • •UIRED? .NO ES , UP/SEPAJ;SU? .; p YES O g . �°�-. ��a- �.Fa- „�"`° $■t ��'� �. � b ,.. £ �.a 1 0 :': 1 y , �•Qt�D�.. � YES 7 .,.,.. .__ Bulletin#100-January 7,2005 Page 2 of 4 k�Handouts�Permit Application L..ECTRICAL PERMIT INFORMATION a y RESIDENTIAL COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE Service or Feeder Each Add'n ❑ Single Family Square Feet (First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50 ❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00 (Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00 ❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50 (Inspected separately) $69.50 ❑ 601-800 amp 398.50 168.50 ❑ 801 - 1000 amp 486.50 203.50 NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00 Service Feeder - ❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00 ❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00 ❑ 401 -600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL ❑ 601 -800 amp 247.00 132.00 ❑ 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 ❑ 601 - 1000 amp 398.50 Service or Feeder ❑ over 1000 amp 443.50 ❑ 0 to 200 amp $87.00 ❑ 201 -600 amp 141.00 ❑ #of circuits to be added/altered ❑ over 600 amp 212.50 (1-5 circuits-$89.00;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 35%of Permit Fee ❑ Service- 1,000 amps or greater ❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility MOBILE HOMES ❑ Service or feeder only $69.50 , ❑-Service and feeder $113.50 TEMPORARY SERVICE MOBILE HOME/RV PARK Residential/Multi-Family $61.00 ❑ #of service or feeders (First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity ❑ 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 ❑ #of Signs (First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea) liK-Low Voltage ❑ Swimming pool/hot tub $87.00 Sqyare Feet to be served by system(s) 3 C 06 (Includes additional circuit,if required) Pr--Fire Alarm System i 1 ❑ Yard Pole meter loops $104.50 ❑ Security Alarm System ❑ Additional Plan Review $104.50/hour ❑ Voice Cabling (for modified submittals) ❑ Data Cabling ❑ I ❑ Automation Fee on all Permits .. $5.00 (Per Systeni(s) 1•t 2500 ft2-$61.00; AS Each add'n 2500 ft2-16.00) •Per WAC 296-46-910(5)(b)(I&u/ J it3yr Bulletin#100-January 7,2005 Pat 3 of 4 k\Handouts\Permit Application