08-102981 CITY OF A 4111 91 - _L 0 42,_q_E
Federal Way PERMITT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP J
33325 8TH AVENUE SOUTH•FO BOX 9718 U N APPLICATION
FEDERAL WAY,WA 98063-260 TO / /
253-835-2607•FAX 253-835-2609 J
www atttofjt.deralwny.corn �FRA� `A/Ai� s
rn �E atf�
The following is req ,/�for�t[tion-an incomplete application will not be accepted. Please print legibly(in ink)or type.
111PROPERTY INFORMATION
SITE ADDRESS_ 3/J ? // 1Q-> C/f I( ��(oy ^ } ( %j7/ SUITE/UNIT# 1"L''
ASSESSOR'S TAX/PARCEL# 0 [ / fa ,y_ `0 7 Z_ LOT SIZE(s
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 XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
1.41'1i77oP (7,1' Pa_tL S7-2 77 6-,4-2-s ilio,ec kir- Gi chs f9-.'& /-Icieft) •5;7206-s
77- '4-,t. 5x/sr/.,,%C- :Cys-re-,vi
PROJECT NAME(Name of Business or Owner Last Name) K ie6(4 F}(e' -/f}4'6( .Sr'},i,;t--
• PEOPLE INFORMATION
PROPERTY NAME k! c PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME AjP�LICANT NAME OFFICE PHONE
ne_ ,4 iirCea /NG elc /92(e i,g,n)/ (c/Ar ) 17s - 6A7
MAIJ{UNO ADDRESS f CITY,STATE,ZIP CELL PHONE
(!_ l% ��rX / (P /%Li J, 9cY3 ( '/2fl %3i - 7060 to
CITYF FEDERAL,W�Y BUSINESS LICENSE NUMBER / EXPI TION DA E FAX NUMBER
)if
O S (/Ol00,..3 --op Z�j'j j ( `1��5 ) 77s - SVCONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL AWELESS C.
,- l-1,2r�?. - 50Y/V/Z —/`j-C�t s2rcr4-
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect 0 Tenant 0 Agent 0 Other ( ) -
PROJECT N9E PRIMARY PHONE E-MAIL ADDRESS 21Cfi e
CONTACT k ic r1 aIn L/,,"r<U f (to S!) lC'3/' - ?cc:L /41.,62rYt7-cNi�zethim- xok
LENDER NAME Per RCW 19.27.095:
Lender information is required Vf project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) _
■ DETAILED BUILDING INFORMATION
EXISTING USE '-',./it c.i'_ PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 5 (C C
SPRINKLERED BUILDING? 0 YES KNO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES f NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING ST TOTAL PROPOSED sr TOTAL Sr
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fucture 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(Commercia)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sulks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS gale)
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 pa s lication.,
SIGNATURE: C.2�' DATE --/9-C6
Property Owner and/or Au rized Agent
v v+ .aww`«uwmeaWx«w...
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January I,2008 Page 2 of 4 k\Handouts\Permit Application
. ELECTRICAL PERMITINFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
U Single Family Square Feet
(First 1300 ft2-$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 U Over 600 volts surcharge $98.00
U 201 -400 amp 155.50 76.50 U Mast or meter repair $106.00
U 401 - 600 amp 212.50 106.00
U 601 -800 amp 272.00 145.50 ALTERED COMMERCIAL/INDUSTRIAL
U Over 800 amp 389.50 291.00 Service or Feeders
U 0 to 200 amp $125.50
ALTERED SINGLE/MULTI FAMILY U 201 -600 amp 291.00
U 601 - 1000 amp 439.00
Service or Feeder
U over 1000 amp 489.00
U 0 to 200 amp $96.00
U 201 -600 amp 155.50 U #of circuits to be added/altered
U 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
U Service- 1,000 amps or greater
U Mast or meter repair $57.50 U Medical/Educational/Institutional Facility
MANUFACTURED HOMES
U 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
U 0-100 amps $76.50
❑ 101-200 amps 98.00
❑ 201-400 amps 115.00
❑ 401-600 amps 155.50
U over 600 amps 168.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats U #of Signs
(First-$57.50;add'n-$17.50/ea) (First sign-$57.50;add'n sign$27.00/ea)
-Low Voltage U Swimming pool/hot tub $115.00
Square Feet to be served by system(s) //COO (Includes additional circuit,if required)
Ei Fire Alarm System ❑ Yard Pole meter loops $76.50
❑ Security Alarm System U Additional Plan Review $115.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
U Automation Fee on all Permits .. $5.50
0
1■t 2500 ft2-$67.50;
Each add'n 2500 ft2-$17.50) •Per WAC 29646-910(4,)(1&ii)
Bulletin#100-January I,2008 Page 3 of 4 k\Handouts\Permit Application