05-105015 r
0,A •
Federaiway RECEIVED — — — — — —
COMMUNITY DEVELOPMENT SERVICES PERMIT SF MF CO ME EL PL DE EN FP
33325 8m AVENUE SOUTH•P0 BOX 9718
253-83607 FAX 253-835 WAY,WA 2B cAP P LI CATI O N To
1nmw.dWoffederalwau.com
The , 1. ifs . •..'t ,,.; „ ,tete ,
- Li, will not be • _ Please , • t ._ an ink)or ,,,-.
PROPERTY INFORMATIIO.N
SITE ADDRESS ���, � /�!'k. r7 J. SUITE/UNIT# 4
ASSESSOR'S TAX/PARCEL# / el � $ - _.0_la LOT SIZE(sfi
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Zile 4,1". ,/'ate .. G14)'-i
(Att2ch separate P.ge.f /legal description)
M PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEER)NG RE PREVENTION SYSTEM\
---�
PROJECT DESCRIPTION(Provide detailed dcrcription of work included on this permit onhi)
.7.---4.--44 4-- 04/l rir1 !! 7 ,
40_1_
i
PROJECT NAME(Name of Business or Owner Last Name) (..G//G/L 4.A,
_Q PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER t ��vGi`1' ( ) -
MAILING ADDRESS CRY.STATE.ZIP
2. 5-"I` 'kfi )/S) rifik// /i'itr , '7,9
CONTRACTOR COMPANY NAME ,p,.gL//A' APPUCAN®T�NA�M�°/&I //�+., /� OFFICE PHONES /} /�
MAILING ���K.-/ hr,7 (- ✓ �`!..'e,81 (.�G's,rerr ( 7 -) q ` x,6,e,
CITY,STATE,ZIP / CELL PHONE
/712 (i140' elf eh`—, i.4 q; ( i'
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER TAT/ON DATE FAX NUMBER f
a -O el-1 Q g 1 4-B L 0 / /05- (T; 3 -7fz0
CONIRACTOR'S REGISTRATION NUMBER(copy of card required with each application)- EXPIRATION DA
TE
. ",rS et *kQ2, g./14_- 07 / /66
APPLICANT COMPANY NAME ,.,{ APPLICANT'glom ` OFFICE PHONE
IN
Gie -- '1`1G,rlj-x12: 7-",640 a� a,9er ( o ?9,o -9 �
CITY,STATE,ZIP CELL PHONE
/ �RELA3
MP 6O. T
/ A , , , /zq#, 4,, ( _) -
FAX NUMBER
o Architect o Tenant Agent a Other(Describe) (/ice r-I 3S3- -5-''7 l
CONTACT NAME PRIMARY PHONNE�y [ `EMAIL ADDRESS '�J ,l
LENDER AIT-1,100i19-27-09.4%:; Iqf rt la, NAME
= jf,P u- ;$5 000 „<,-
MAILING ADDRESS C1TY.STATE,ZIP PHONE
( ) - I
/� • DETAILED BUILDING INFORMATION
EXISTING USE C>i 7 G/ PROPOSED USE &'74r/17/14 fid '// l
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ •/>G9� � �
SPRINELERED BUILDING? )(YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES o NO
WATER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
4 •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
EQ.FT• Sg.FT. SQ.FT.
BASEMENT
FIRST / /''
Te /01Z2
SECONDTHIRD
/ /
FOURTH
ADDITIONAL FLOORS(DESCRIBE) / '- -
DECK(COVERED?)
, --1-
/ /„
GARAGE 0 CARPORT 0
s
NUMBER OF FLOORS raorosso corer °'gra'°»r: *are / g arat ter, ;.
**NEW HOMES ONLY" NUMBER OF BEDROOMS , ESTIMATED SELLING PRICE $ _...
FIXTURES
Intl irate number of each type of frxlure to be installed or relocated as part of this project Do not include existing fixtures to remain.
DEICCHAlITICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS icaommoms WOODSTOVES
BOILERS NiREPIACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Sbower Combo) SHOWERS WATER CLOSES unmet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS mailroom.smmo VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I ander penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I
am authorised 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 which may be made by any person,including the undersigned,and filed against the City of Federal Wag,but only where such claim
anis isesaout of t In reliance of the city,incl its officers and employees,upon the accuracy of the information supplied to the city as a partthof
NAME/ DATE 0_.,z Af,....5(Signature) (Title)
RELATIONSHIP TO PROJECT ❑Owner 0 Agent `Contractor 0 Architect ❑ Other
y Wffi,a
o NEW a ADDITION a.ALTERATION a REPAIR a:TEN NT
BUILDING SHELL ONLY? a YES- a NO BASIC PLAN? a"YES ' a NO
ZONING DESIGNATION CHANGE OF ESE? a YES a NO
NEW ADDRESS REQUIRED? :. a YES;; a NO UP/SEPA/SU? a YES. :a NO
PLATTED LOT? a YES: a NO DEMO PERMIT REQUIRED? a YES ( a NO
Bulletin#100-January 7,2005 Page 2 of 4 lc Handouts\Permit Application
II 410
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet Service or Feeder Each Add'n
(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
U 601-800
amp 398.50 168.50
O 801- 1000 amp 486.50 203.50
NEW MULTI FAMILY(three units or more) U 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
U 601 800 amp 247.00 132.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0to200amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201-600 amp 264.50
Service or Feeder 173 601- 1000 amp 398.50
CI to 200 amp $87.00 ❑ aver 1000 amp 443.50
❑ 201-600 amp 141.00 U #of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea)
Li 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
U Service or feeder only $69.50
❑ Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/MultiPamily $61.00
❑ *of service or feeders
(First service/feeder-$69.50:each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
U 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)
Low Voltage �,t']►J��jj//'� ❑ Swimming pool/hot tub $87.00
Feet to be served by system(s) /3td(., (Includes additional circuit.If required)
Fire Alarm System U Yard Pole meter loops $104.50
❑ urity Alarm System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0 LiAutomation Fee on all Permits .. $5.00
(Per System(s)1a 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00)•Per WAC 296-46-910(51(b)5&W
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application