08-103595 4111 0
CITY QF RECEIVE off'' - / 3 ''
Federal Way PERMIT
A., COMMUNITY DEVELOPMENT SERVICESSUL 2 9 20 SF MFC ME EL PL DE FP
33325 8r"AVENUE SOUTH•PO BOX 97 APPLICATION TD W
FEDERAL WAY;AA 98063-9718
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253-8352607•F 6
Int...,;[�,t��rE ;t l<<;, F FEDERAL WAY
The following is requiredtion-an incomplete application will not be accepted. lease print legibly(in ink)or type.
7 r� 7 D • PROPERTY INFORMATION
SITE ADDRESS 31 -f S 3 1 4.14 (I . H r-
J r 1-C cie-✓'at �et SUITE/UNIT#
(>
ASSESSOR'S TAX/PARCEL# D z / 0 - 47 a7 6 LOT SIZE(Si)(sfl
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION . ELECTRICAL 0 ENGINEERING LFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) /
4 lcti te1 3 kart-, /S)volle. a.,set tf s ,ra ce.
ROJECT NAM (N. -of Business or Owner Last Name) E sge+it &,.....12 — Pt,tlf l i'CI'1A R
• PEOPLE INFORMATION
•ROPERTY 'NAMEPRIMARY PHONE
".•WNER Pani 1 I CM. (eAl Ter Asg-O 64;ir-4 ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
Od
4" 0 120 1. Oa3 ft) - Siwf- D ea 5 , w q-, gist)zo
CD LaCONTRATOR; •. COMPANY NAME APPLICANT NAME OFFICE PHONE
�° ® J GL•tPa.^o U--, Se UAW''l ha Raede i l t4r k (?L1 6 ) 9.6 -SZSO
ILL CL Z5 MAILING ADDRES 4 CITY,STATE,ZIP CELL PHONE
O 2. 2 (7q >S1" s Sea _/ w4/ C")I3c/ (2 ) 3sq -126g
c 0:c2 M, CITY OF EDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
i• ate"' !- 1 `q$ — lS(6 �3 —00...�.13 Z, ' 2/2 1 /o (2o6 ) 3Lq -96'Zg'
1:3 ZS
W 0 CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
N 0
d G a,Ct.� SS 2-3 k:S at / 3o/bg rk.:-lee 9w(arot ia�lseu.c i]1.
JC T COMPANY NAME APPLICANT NAME OFFICE PHONE/ . CO I2
'vv77 ��_ S ((
CO 1"l Q MAILING ADDRESS 8 tom- CITY.STATE,ZIP CELL PHONE f
f I( / -
( )
RELATIONSHIP TO PROJECT � � 11 FAX NUMBER
ID Architect ❑ Tenant ❑Agent ❑ Other CA,(A 4V A c 'v f ( ) (1 -
PROJECT NAME /I PRIMARY PHONE E-MAIL ADDRESS
CONTACT 5 �
ae_ q s Q.ko - ( ) i( - 1f
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE.ZIP PHONE
( )
U DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 7 , 0 O O
SPRINKLERED BUILDING? ❑YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
0
a
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**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.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC[Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS or Tub/Shower Combo) LAYS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSE.lb(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 application.
SIGNATURE: DATE O 7/2 ( CJ
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
c NEW ❑ADDITION c ALTERATION o REPAIR c TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? c YES C NO
ZONING DESIGNATION CHANGE OF USE? ❑YES c NO
NEW ADDRESS REQUIRED? c YES ❑NO UP/SEPA/SU? ❑YES to NO
PLATTED LOT? YES c NO DEMO PERMIT REQUIRED? c YES c NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Permit Application
I
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Li Family Square Feet Service or Feeder Each Add'n
(First 1300 ft,-$115.50;Each add'n 500 ft2-$37.00) ❑ 0 to 100 amp $125.50 $76.50
❑ Detached outbuilding or garage ❑ 101-200 amp 155.50 98.00
(Inspected with service) $48.50 ❑ 201-400 amp 291.00 115.00
❑ Detached outbuilding or garage ❑ 401-600 amp 339.50 136.00
(Inspected separately) $76.50 ❑ 601-800 amp 439.00 186.00
❑ 801 - 1000 amp 536.50 224.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 584.50 311.50
Service Feeder
❑ Up to 200 amp $125.50 $37.00 ❑ Over 600 volts surcharge $98.00
❑ 201 -400 amp 155.50 76.50 ❑ Mast or meter repair $106.00
❑ 401 600 amp 212.50 106.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 272.00 145.50
❑ Over 800 amp 389.50 291.00 Service or Feeders
❑ 0 to 200 amp $125.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 291.00
❑ 601 - 1000 amp 439.00
Service or Feeder ❑ over 1000 amp 489.00
❑ 0 to 200 amp $96.00
❑ 201 -600 amp 155.50 ❑ #of circuits to be added/altered
❑ over 600 amp 234.00 (1-5 circuits-$98.00;Add'n circuits,$7.50/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$76.50;Add'n circuits$7.50/ea) $98.00 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $57.50 ❑ Medical/Educational/Institutional Facility
MANUFACTURED HOMES
❑ Service or feeder only $76.50
❑ Service and feeder $125.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $67.50
❑ #of service or feeders
(First service/feeder-$76.50;each add'n-$50.00) Commercial/Industrial Service or Feeder Ampacity
❑ 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 ❑ #of Signs
(First-$57.50;add'n-$17.50/ea) (First sign-$57.50;add'n sign$27.00/ea)
Low Voltage ❑ Swimming pool/hot tub $115.00
Square Feet to be served by system(s)� Cf00 (Includes additional circuit,if required)
Fire Alarm System ❑ Yard Pole meter loops $76.50
❑ Security Alarm System ❑ Additional Plan Review $115.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabli
❑ ng Li Automation Fee on all Permits .. $5.50
15'2500 ft2-$67.50;
Each add'n 2500 ft,-$17.50) 'Per WAC 296-46-910(5)(b)9&8
Bulletin#100-January 1,2008 Page 3 of 4 k\Handouts\Permit Application