06-106469 i , c,„n 0 441r."**".
oCo - off /
Federal Way?FCE - PERMIT SF
COMMUNITY DEVELOPMENT SERVICES MF CO ME EL PL DE EN FP
39325 8TH AVENUE SOUTH•PO BOX 9718 7 2°°6A P P LI CATION TD
FEDERAL WAY,FAX
53-83-260 / /
253-835-2607•FAX 253-835-2609
www.ci t yb((ederolwa y.rom
,1LY OF FEDERALWAY
The following is riiitii WtiVhJ'drYf�atTion-an incomplete application will not be accepted. Please print legibly(in ink)or type:
'. •• •• . .. - PROPERTY INFORMATION - ••
•
t 1
SITE ADDRESS X4-7 CCC ^ty �Ti. . _i_'�!SMIZ*-7 '►il/t4' " •- SUITE/UNIT# /4/C
LP Y
ASSESSOR'S TAX/PARCEL# �ca�C ICs ` J - r LOT SIZE (sj) _
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION .
TYPE OF PERMIT ❑ BUILDING O PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
\ . - .fir' ' c-76 -e h9 - t v-C h(--.• -, zw/ `. i 7(7 /* 7? 4615.
_.`{ v .Y( ( 1`L:;-' CI' is rqlj 6'.e44 0
PROJECT NAME(Name of Business or Owner Last Name) � ,V17 /.
. U PEOPLE INFORMATION •
PROPERTY NAME - "PRIMARY PHONE
OWNER ClU-VC rd (C\P) FOE) ( )
MAILINGWDDRESS CITY,STATE,ZIP - E-MAIL ADDRESS
CONTRACTOR COMPANY �� APPLICANT NAME OFFICE PHONE
kiC
NGAD ESS , CIT ,STAT IP CELL PHONE _C'eI1Z..V' 'P�_ s . i,op, +� (-00b`3 -i!O
CITY OF FEDERAL W BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
ao-o-a - / QS c( -- co-- BI-- ( )
COPY of cord required CONTRACTOR'S REGISTRATION NUMBE EXPIRATION DATE E-MAIL ADDRESS
CtT
with each application I > 4. c 1 /✓54 j -%3 FL
APPLICANT COMPANY NAM / `'� / APPLICANT NAME OFFICE PHONE
Co -1`a- a r • ( ) -
MAILING ADDRESS - CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other ( ) - .
PROJECT NAME PRIMARY PHONE 1 E-MAIL ADDRESS
CONTACT CV\f‘ `7 1--)A�'i l c 1 •--. I'l
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
•
'' ■ DETAILED BUILDING INFORMATION •
•
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ •VALUE OF PROPOSED WORK $ COO
SPRINKLERED BUILDING? 0 YES 0 NO FIRE.SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
■ PROJECT FLOOR AREAS
AREA DE' • ION EXIS PROPOSED TOTAL
BASEMENT SQ. . SQ. FT. SQ. FT.
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
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(commorrial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toiot)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify 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 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 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.
I
NAME/TITL i, 0 / r4,... 1.- <be.- j t , L' DATE / — -` 0 C t`)
(SI n re) (Till
RELATIONSHIP TO PRO`JE T 0 Owner/ 0 Agent 0 Contractor 0 Architect 0 Other-
7
o NEW o ADDITION ❑ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES a NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED?. o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 1,2006 Page 2 of 4 k\Handouts\Permit Application
• III
•r •
•
. ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
• Service or Feeder Each Add'n
❑ Single Family Square Feet
(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 ❑ 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 Li Over 600 volts surcharge $91.50
❑ 201 -400 amp 145.00 71.50 ❑ Mast or meter repair $99.00
❑ 401 -600 amp 198.50 99.00
0 601 - 800 amp 254.00 136.00
ALTERED COMMERCIAL/INDUSTRIAL
❑ 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
❑ Oto200amp $89.50
❑ 201 - 600 amp 145.00 ❑ # of circuits to be added/altered.
❑ over 600 amp 218.50 (1-5 circuits-$9I.50;Add'n circuits,$7.00/ea)
CI 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
MANUFACTURED HOMES
❑ Service or feeder only $71.50
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $63.00
❑ #of service or feeders
(First service/feeder-$71.50;each add'n-$46.50) Commercial/Industrial Service or Feeder Ampacity
1 ❑ 0- 100 amps $71.50
❑ 101-200 amps 91.50
O 201-400 amps 107.50
❑ 401-600 amps 145.00
❑ over 600 amps 157.00
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 ] /_ �-1 ❑ Swimming pool/hot tub $107.50
Square Feet to be served by system(s) SP 1,`J�L! (Includes additional circuit,if required)
1i,Fire Alarm System ❑ Yard Pole meter loops $71.50
❑ Security Alarm System • ❑ Additional Plan Review $107.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0 CIAutomation Fee on all Permits .. $5.00
l.t 2500 fts-$63:00;
Each add'n 2500 ft7-16,50) •Per WAC 296-96-910(5)(6)(i&ii)
Bulletin#100-January I,2006 Page 3 of4 k\Handouts\Permit Application