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07-100420 j City of Federal Way Electrical Permit #: 07-100420-00-EL Community Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: EVERGREEN PARK 4 ADULT FAMILY HOME Project Address: 142 S 295TH PL Parcel Number: 543721 0160 Project Description: Add (4) circuits for electrical work in conjunction with conversion of garage are to habitable space. Owner Applicant Contractor MARIJANA DUMINICA MARIJANA DUMINICA EVERGREEN PARK#3 EVERGREEN PARK#3 EVERGREEN PARK#3 17126 SE 29TH PL 17126 SE 29TH PL 17126 SE 29TH PL BELLEVUE WA 98008 BELLEVUE WA 98008 BELLEVUE WA 98008 Additional Permit Information Electrical Fixtures Circuits-Residential 4 PERMIT EXPIRES Tuesday, July 24, 2007 Permit Issued on Thursday, January 25, 2007 I hereby certify that the above i formation is correct and that the construction on the above described property and the occupancy and the use I be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: Date: /7261C FIB ALE® THIS CARD IS TO REMAIN ON-SITE CITY of Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 07-100420-00-EL Owner: MARIJANA DUMINICA Address: 142 S 295TH PL FEDERAL WAY, WA 98003-3659 This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections are logged on the back of this card. ❑ Slab/Concrete Floor(4255) ❑ Ditch cover(4030) ❑ Pool Bonding (4195) Approved to place concrete Approved Approved By Date By Date By Date ❑ Temporary Power(4275) ❑ Service(4235) ❑ Feeders/Sub-panels(4045) Approved Approved Approved By Date By Date By Date ❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical(4055) Approved Approved Approved By Date © 9 By Date Bye 0> Date ❑ Under-slab groundwork(4295) Approved By Date Blinding Divisic Ah, CITY OF 33325 Eighth Av. Federal Wa • Box 9 Federal _ Phone Waa y 98067, hane 253-835-2607 Fax 253-835-2609 INSPECTION NO CE ADDRESS: tV.Va, S a 0 7 V #: m '1_-1 fma y - c .9.L.. q �aQ� - „tea IF YOU HAVE ANY QUESTIONS CALL (253) 835- Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD FOR DETAILS. DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page of dot>R.� ■RECEIVED�V I 0 / O ' y ___0 Federal Way PERMIT ' '' COMMUNITY DEVELOPMENT SERVICES _SF MF CO ME 0•L DE EN FP '33325ETMAVENwUASOUTH•PO BOX911 2 5 zo( PPLI CATION ' RN PBOBRAL WAY,WA 980G3-9718 .253-835.2607•FAX 253-835-2609 wow dhiuffedenthunv.'CITRY OF FEDERAL WAY The following is regal Gti n-an incomplete application will not be accepted. 'lease print legibly(in ink)or type. ■ PROPERTY INFORMATION SITE ADDRESS ,&,..9.— S „..i2( P--- SUITE/UNIT# ASSESSOR'S TAX/PARCEL# ! I - _ Q LOT SIZE ND LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) Mead,.eprnte Page for lengthy 1..921 desoptio,l ■ PROJECT INFORMATION ❑ BU TYPE OF PERMIT BUILDING 0 PLUMBING 0 MECHANICAL ❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJ/ ESCRIPTI N(Provide detailed description of work inciudgd on this permit only) ( ti 1 f 1M ✓ �� /' 1 _/ '. - �' t-c"c c soll i.tr. .a WM ill ' 1.: 2 W PROJECT NAME(Name of Business or Owner Last Name) /f� 7" V.'s') t///AI)04 NI PEOPLE INFORMATION PROPERTY NAME/�� ` ,�/ I PRIMARY PHONE / / 7 OWNER �yy MAILING//1/'//T6�-1 �/J� �'i'71ni/llle17z-- /J wry ^ ^� ([/�K�f �/ /' �D -'c '-�- G CT etd ' a ADDR$SS CONTRACTOR COMPANY NAME A,P .I NT ME OFFICE PHONE Ce ,1 t E l� 1v// `-� c� h'11/y/�'hZ ,E,'G' I ..C''" /2 MAILING ADDRESS CITY,STATE,ZIP CELL PHONE ( ' - CITY OF FEDERAL.WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER ( )' - COPY olevd»gvlrad CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS CZth v.c vppllc.aon APPLICANT COMPANY N APPLICANT NAME - OFFICE PHONE ( ) - MAILING A ESS CITY,STATE,ZIP CELL PHONE ( ' RELATIONSHIP TO PROJECT FAX NUMBER o Architect o Tenant ❑Agent o Other ( PROJECT NAME J- f PRIMARY PHONE E-MAIL ADDRESS '� CQNTACT (ul G///t ( ) - LENDER NAME Per RCW 19.27.095: Lender information is required if project value exceeds$5,000 MAILING ADDRES—■ CITY,STATE,ZIP PH t NE . - J • DETAILED BUILDING INFORMATION hif EXISTING USE 7I. (-I it LC L ` C`c l PROPOSED USE ' /— EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 67;tr1 SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO WATER SERVICE PROVIDER AKEHAVEN ❑ HIGHLINE ❑ TACOMA o PRIVATE(WELL) SEWER SERVICE PROVIDER iCL LAKEHAVEN ❑ HIGHLINE ci PRIVATE(SEPTIC) as.:rzmmn.mnvn.msxmrrr»s:vuv.v........ .. ..... ............... .....wrn .. .. _ __ AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ. FT. SQ.FT. BASEMENT FIRST SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(O COVERED OR ❑UNCOVERED?) I) 7 GARAGE 0 CARPORT 0 NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING Sr TOTAL PROPOSED Sr TOTAL ST - **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ N 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. MECHANICAL Value of Mechanical Work $ __ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) MR HANDLING UNITS - EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS . FIREPLACE INSERTS HOODS]commercial) COMPRESSORS FURNACES RANGES DDC')'S GAS LOG SETS REFRIG. SYSTEMS • PLUMBING BATHTUBS(or Tub/Shover Combs LAVS(aatluaom Sinks) - URINALS . .MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS • DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roum) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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 (including 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 f the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE ? - DATE 7/2— -/C S final (Title] RELATIONSHIP TO PROJECT Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other Pd✓'.Vh. 4 �} o NEW o ADDITION ❑ALTERATION o REPAIR C TENANT IMPROVEMENT. BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? o YES ❑ NO ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? 0 YES ❑NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO • Bulletin#100—January 1,2007 Page 2 of4 k\Handouts\Permit Application DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8`"Avenue South CITY OFF " PO Box 9718 Federal Way RECEIVED Federal Way WA 98063-9718 M 253-835-2607;Fax 253-835-2609 JAN 2 5 2007 www.citvoffederalway.com CITY OF FAl1iAA4 WAY Affidavit in Lieu of. GeneraT'Contractor Registration State of Washington ) County of King ) /'7s P1P- cNL( /AO /4 • ,state as follows: (Print name as signed) 1. I have made application for a building permit from the City of Federal Way,Washington. 2. I understand that state law requires that all building construction contractors be.registered with the State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the Revised Code of Washington(RCW), a copy of which is printed on the reverse side of this affidavit. 3. I understand that prior to issuance of a building permit for work that is to be done by any contractor, the City of Federal Way must verify either that the contractor is registered by the State of Washington,or that one of the exemptions stated under RCW 18.27.090 applies. 4. In order to provide verification to the City of Federal Way of my compliance with this requirement,I hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,I consider the work authorized under this building permit to be exempt under No. a: , and will therefore, not be performed by a registered contractor. I understand that.I be waiving certain rights that I might otherwise have under state law in any decision to engage .1 unregistered contractor to perform construction work. APPLICANT'S IGNATU' .Agit Si ed and swo to before me Ns , Day ofKM.>20�fL? (iyacet3ka/bR6y-6, No� s amfr t) xtary's ignare NOTARY PUBLIC in and for the State of Washington,residing at___Kt_kilF.County My Commission expires: r O 9 Bulletin#116—October 1,2004 Page 1 of 2 k:\Handouts\Contractor's Affidavit 1 • ELECTRICAL PERMIT INFORMATION - 'r RESIDENTIAL COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAAL SERVICE Service or Feeder Each Add'n ❑ Single Family Square Feet (First 1300 ft2-$111.00;Each add'n 500 ft2-$35.50) ❑ 0 to 100 amp $120.50 $74.00 ❑ Detached outbuilding or garage ❑ 101 -200 amp 149.50 94.50 (Inspected with service) , $47.00 ❑ 20.1-400 amp 280.00 111.00 ❑ Detached outbuilding or garage ❑ 401-600 amp 327.00 131.00 (Inspected separately) $74.00 ❑ 601-800 amp 423.00 179.00 ❑ 801 - 1000 amp 516.50 216.00 NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 563.00 300.00 Service Feeder ❑ Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50 ❑ 201 -400 amp 149.50 74.00 ❑ Mast or meter repair $102.00 ❑ 401 -600 amp 205.00 102.00 ALTERED COMMERCIAL/INDUSTRIAL ❑ 601 -800 amp 262.00 140.50 ❑ Over 800 amp 375.50 280.50 Service or Feeders • ❑ 0 to 200 amp $120.50 ALTERED SINGLE/MULTI FAMILY ❑ 201.-600 amp 280.50 ❑ 601 - 1000 amp 423.00 Service or Feeder ❑ over 1000 amp 471.00 ❑ 0 to 200 amp $92.50 0-201 -600 amp 149.50 ❑ #of circuits to be added/altered ❑ over 600 amp 225.50 (1-5 circuits-$94.50;Add'n circuits,$7.00/ea) pt j COMMERCIAL/INDUSTRIAL PLAN REVIEW 4 of circuits to be added/altered (1-4 circuits-$74.00;;Add'n circuits t$7.00/ea) $94.50 plus 35%of Permit Fee ❑ Service - 1;000 amps or greater ❑ Mast or meter repair $55.00 ❑ Medical/Educational/Institutional Facility MANUFACTURED HOMES ❑ Service or feeder only $74.00 ❑ Service and feeder $120.50 TEMPORARY SERVICE MOBILE HOME/RV PARK Residential/Multi-Family $65.00 ❑ # of service or feeders (First service/feeder-$74.00;each add'n-$48.00) Commerdalflndustrial Service or Feeder.Ampacity ❑ 0- 100 amps $74.00 ❑ 101-200 amps 94.50 ❑ 201 -400 amps 111.00 ❑ 401-600 amps 149.50 ❑ over 600 amps • 162.00 MISCELLANEOUS SERVICE/EQUIPMENT ❑ 4 of Thermostats ❑ 4 of Signs (First-$55.00;addn-$17.00/ea) ' (First sign-$55.00;add'n sign$26.00/ea) ❑ Low Voltage ❑ Swimming pool/hot tub $111.00 Square Feet to be served by system(s) (Includes additional circuit,if required). ❑ Fire Alarm System ❑ Yard Pole meter loops $74.00 ❑ Security Alami System ❑ Additional Plan Review $111.00/hour ❑ Voice Cabling (for modified submittals) ❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00 ❑l 1•,2500 ft2-$65.00; Each add'n 2500 0417.00) •Per WAC 29646-910(54b416 ii) . • Bulletin#100-January 1,2007 . Page 3 of 4 kUiandouts\Permit Application