06-100143 • A 41111 I-1C3b
CITY OF 0-6—I— g
FederaIw4ECEIVED
PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DEE FP I
33305 8w AVENUE SOUTH•PO BOM748 748 1 2 200
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FEDERAL WAY,WA 98063-97 8 '1'D
053-835.0607•FAX 053-835.0609
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www,dtw/fe Y. tOF FEDERALW
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The following is
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u red Information-an inco .lete a•plication will not be accepted. Please rant legibly in in or pe.
■ PROPERTY INFORMATION
SITE ADDRESS 33s 30 1,6-‘ W 0.1 S SUITE/UNIT# . 1 OZ.
ASSESSOR'S TAX/PARCEL# a Z CIP S 0 CJ - 3 fp O LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING . 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING (9 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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PROJECT NAME(Name of Business or Owner Last Name) t- vl' lid'. I\% u wt S R-er^`
PEOPLE INFORMATION
PROPERTY . NAME PRIMARY PHONE
OWNER Ac,co bo„A, ►Acte;q' Sery i cc- ( )
MAILING ADDRESS ADDRESS CITY,STATE,ZIP
1S1'1 Gre¢Awo( Ave t\1• 52c.k-0e � wA '$(O3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
A1aJwt e-.e46cf \AC• JAmes Fosses (S(at ) A(,1- - (oszo
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
?O , cox 3A40-1 . L•at $sa�-340-1 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ( EXPIRATION DATE FAX NUMBER
? c 4 0- 1 0 i 4 5Z-13 L . • (360 ) 43$= 421•{¢
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
t 452- a s ,4L4RWIG$0'55-ca 2 / I b /o-7
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑:Tenant 0 Agent 0 Other(Describe) ( ) , -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
J&oleS Fos (5(70.) 4143--610-1
LENDER
MAILING ADDRESS CITY,STATE,ZIP PHONE
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■ DETAILED,BUILDING INFORMATION'
EXISTING USE PROPOSED USE qe)6 j• CQ
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ _//
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED%REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑LAKEHAVEN . 0 HIGHLINE 0 PRIVATE(SEPTIC)
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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 0 CARPORT 0
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.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS . FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING •
BATHTUBS(or Tub/shower combo) SHOWERS WATER CLOSETS(Toner) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I cert(fy 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 arty 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 of 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 — J DATE 1 i 12 /D A
grate 1 / (Title)
RELATIONSHIP TO PRO CT. D Owner Ci Agent a Contractor ❑Architect 0 Other •
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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-$107.50;Each add'n 500 ft2-$34.50) ❑ 0 to 100 amp $117.00 $71.50
❑ Detached outbuilding or garage ❑ 101.-200 amp 145.00 91.50
(Inspected with service) $45.50 0 201-400 amp 272.00 107.50
❑ Detached outbuilding or garage ❑ 401-600 amp 317.00 127.00
(Inspected separately) $71.50 ❑ 601-800 amp 410.00 173.50
❑ 801 - 1000,amp 500.50 209.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 546.00 291.00
Service Feeder
❑ Up to 200 amp $117.00 $34.50 ❑ Over 600 volts surcharge $91.50
❑ 201-400 amp 145.00 71.50 ❑ Mast or meter repair $99.00
O 401-600 amp 198.50 99,E ALTERED COMMERCIAL/INDUSTRIAL
Q 601 -800 amp 254.00 136.00
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❑ Over 800 amp 364.00 272.00 Service or Feeders
❑ 0 to 200 amp $117.00
ALTERED SINGLE/MULTI FAMILY ❑ 201-600 amp 272.00
❑ 601-.1000 amp 410.00
Service or Feeder ❑ over 1000 amp 456.50
❑ 0 to 200 amp $89.50
❑ 201 -600 amp 145.00 0 41 of circuits to be added/altered
❑ over 600 amp 218.50 (1-5 circuits-$91.50;Addh circuits,$7.00/ea)
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❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$71.50;Add'n circuits$7.00/ea) $91.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $53.50 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $71.50 •
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $63.00
O #of service or feeders
(First service/feeder-$71.50;each add'n-$46.50) Commercial/Industrial Service or Feeder Ampacity
❑ 0-100 amps $71.50
❑ 101-200 amps 91.50
❑ 201-400 amps 107.50
❑ 401-600 amps 145.00
❑ over 600 amps 157.00
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MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats . ❑ #of Signs
(First-$53.50;add'n-$16.50/ea) (First sign-$53.50;add'n sign$25.00/ea)
Low Voltage ❑ Swimming pool/hot tub $107.50
Sq re Feet to be served by system(s) 3 5pp (includes additional circuit,if required)
a Fire Alarm System ❑ Yard Pole meter loops $71.50
❑ Security Alarm System ❑ Additional Plan Review $107.50/hour
D Voice Cabling (for modified submittals)
❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00
0
(Per Systems)la 2500 ft2-$63.00;
Each add'n 2500 ft2-16.50)*Per WAC 296-46-910(5)(b)(i&ii)
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