12-100080 , electrical
Community
&Federaln.D Way Permit #: 12-100080-00-EL
&Econ.Dev.Services
33325 8th Ave S
Ph:(253)
Federa835-2607 Way,wAx:(253)8 9800335-2609 Inspection Request Line: (253)835-3050
Fa
Project Name: FRANCISCAN MEDICAL GROUP PHARMACY
Project Address: 30809 1ST AVE S Unit K Parcel Number: 072104 9244
Project Description: Add/alter(3)circuits for receptacles,lighting and refrigerator.
Owner Applicant Contractor
CLIFF ROBERTSON EMERALD STATE ELECTRIC EMERALD STATE ELECTRIC
FRANCISCAN MEDICAL GROUP 7215 93RD STREET CT E EMERASE892QD(11/4/13)
1149 MARKET ST PUYALLUP WA 98371 7215 93RD STREET CT E
TACOMA WA 98402 PUYALLUP WA 98371
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Is Use Educational or Institutional? No Service greater than 999 Amps? No
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AVA
Circuits-Commercial 3
PERMIT EXPIRES Saturday, January 5, 2013
Permit Issued on Friday, January 6, 2012
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance ith the laws, rules and regulations of the State of Washington
. -ral Way.
Owner or agent: !�%�_���� Date: A-6
THIS CARD IS TO MAIN ON-SITE • ,
CITY OF ID Construction I ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-100080-00-EL Address: 30809 1ST AVE S Unit K
Project:' CLIFF ROBERTSON FEDERAL WAY, WA 98003 ,.
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.
Cl UFER Ground (4295) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) •
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date By:TC S Date l ((j— /Z By Date
0 Final-Electrical(4055)
Approved
zi:, Date t_p_( Z
0 Rough Electrical Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
CITY OFe.
Federal Way ELECTRICAL RECEIVED
PERMIT APPLICATION
JAN 0 6 ZO2
**Most electrical permits may be obtained on-line at www cityoffederalway com**
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AY
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SITE ADDRESS: 0 �
SUITE/UNIT/SPACE# ASSESSOR'S TAX/PA CEL# ` CURRENT/PROPOSED USE
0701 Ozr - g2- 4-4.-
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PROJECT NAME
Fn rkA
(Tenant or Homeowner Last Name) ki.tiq
ott4e 4s 1 +r' k 111, f
PROJECT DESCRIPTION n [9 �, K L�..t4:4 Fr l
Detailed description of work to •
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
)
NAME PRIMARY PHONE
510e reg
MAILING ADDRESS �-L E-MAIL
ELECTRICAL ��if 5 s(-
G'(�rr1 `e C' tulC�
CONTRACTORS
TY STATE ZIP FAX
Lye114 1. 4 ) -
WA STATE CON CTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5.1rER/1-s�aqzc D I I Airs
NAME ���, \ PRIMARY PHONE
APPLICANT �4'A""L w'" ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT (( S ( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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,
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 p " ation.
SIGNATURE: �� - 1 DATE /—C-- /
PRINT NAME:J,. G(Lt u" Wal LLl t ((((
33325 8th Avenue South•Federal Way•WA♦98003-6325•253-835-2607•fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160—January 1,2011 Page 1 of 2 k:\Handouts\Electrical Permit Application
RESIDENTIP C IMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet 1"Service/Feeder Additional Feeders
(including attached garage): 0- 100 amp x$132.50 x$ 80.50
FEES: First 1300 ft2 -$122.00; 101- 200 amp x$164.00 x$103.50
Each additional 500 ft2 $39.00 201:- 400 amp x`..:$307.00 x$121.00
NEW MULTIFAMILY (3 units or more) 401 600 amp x$358:00 x$143.50
1"Service/Feeder Additional Feeders 601-- 800 amp x$463.00 x$196.00
(3", "200 a p x $132.50 x $ 39.00 801-1000 amp x$565.00 x$236.50
201 400 amp x $164.00 x $ 80.50
Over 1000 amp x$616.00 x$328.50
401 -"600 arnp' ,x $224.00 x $111.50
601 800 amp x $287.00 x $153.50
Over 600 volts surcharge x$103.50
Over 800 amp. x $410.50 x $307.00
ALTERED SINGLE or MULTI FAMILY ALTERED COMMERCIAL
Is'
Service/Feeder 15 Service/Feeder Additional Feeders
x $101.00
0.- 200 amp x$132.50 x$103.50
201, 600 amp x $164.00 201-.600 amp x$307.00 x$121.00
Aver 600 am x $246.50 601-1000 amp x$463.00,., x$196.00
Over 1000 amp -':x_$515.50 x$328.50
Added or Altered Circuits =
1-4 circuits$80.50;each additional$8.00 Added or Altered Circuits
1-5 circuits$103.50;each additional$8.00
Mast or meter repair $60.50
Mast or meter repair $111.50
MANUFACTURED HOMES PLAN REVIEW FEES
Service or feeder only x $ 80.50 Plan Review required only for:
Service-a»d"fee'der'° x" $132.50
• New,or alteration to, service of 1,000 amps or greater
• Medical/Educational/Institutional Facility
$103.50 plus 35%of Permit Fee
(Permit Fee x 35%= +$103.50 = Plan Review Fee)
Plan review for modified submittals $105.50/hour
MISCELLANEOUS SERVICE/EQUIPMENT
LOW VOLTAGE TEMPORARY SERVICE
❑ Fire Alarm System 1st Service/Feeder Additional Feeders
0 Security Alarm System
❑ Voice/Data Cabling 0 ,,,' O;amp x," 71 Ot} ' x $ 32.00
O Other 61- 100 amp x $ 80.50 a $ 39.00
Area to be served by system:
4t3 2110 axiyi.. -x x+103 S0• x $ 51.00
151 2,500 ft2-$71.00;each additional 2,500 ft2-$18.50
201-400 amp x $121.00 x $ 60.50
#of Thermostats
First$60.50;each additional$18.50 $ $0.50
aver600"`amp x $184.50 . .ix $ 92.00
FEE CALCULATIONS
Yard Pole/meter loops/pedestal x$ 80.50 • Fees are determined by the scope of work as indicated.
Portable Generator(transfer equipment) x$101.00 • A$6.00 Automation Fee will be added to all permits.
Ditch cover/inspection only -__x$121.00 • For assistance in calculating fees or completing the
application form,contact the Permit Center at
253-835-2607
33325 8'"Avenue South•Federal Way♦WA♦98003-6325 1 253-835-2607•fax:253-835-2609♦www.cityoffederalway.coin
Bulletin#160-January 1,2011 Page 2 of 2 k:Wandouts\Electrical Permit Application