08-103474 CITYof.4;l w . / - --/--' 7 -
r F°ederralWayRP `)401 f c1
COMMUNITY DEVELOPMENT SERVICES + _ +I T
33325 8,H SF MF CO ME L pL DE EN FP
AVENUE SOUTH PO BOX 9718JUL 2 1 20 � j`
FEDERAL WAY,WA 98063-9718 P P L I C AT I O N TD
253-835-2607•FAX 253-835.2609/'� r�''� p�y//��pp J/� / /
wrvw.dtuoffderrtlutau.wrtl O FEDERAL VVf'1
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
III�} PROPERTY INFORMATION
SITE ADDRESS-"2 I S-Th \JE' e
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# -
—— —— LOT SIZE(sj
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 XELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DEI
SCRzION(Pr detailed es ion of workr included on th' _
1 ``// permit onl
PROJECT NAME(Name of Business or Owner Last Name) V 1 61 l al/ 0VPZek[/,r C/2/fi .-.
• PEOPLE INFORMATION
PROPERTY NAM
OWNER PRIMARY PHONE
MAILING ADDRESS-1 •_\ ,CITY,STATE,ZIP
t J I i 1<oo r 1 I l 0P v e r Qa Ra0 E-MAIL ADDRESS
CONTRACTOR oMP t/N &4 1 JUl ` L
tilA� t(` -VA-CA� CJ APPL[ NAlyf� OFFICE125:PHONE
IN DDRESS� .11';',J� ���[����jo yy
7 q STATE,ZIP ',1 nf,���(+y��n CELL PHONE - �� SS !
CITY OF RA WAY BUSI ESS LICENSE NUMBER t.YII IRWI ,. Il' 01 V1.7�'\i ( ) -
p-10L-18-(30PIRAT[ DATE FAX NUMBER
k /. 31fc c ► —
RACTOR' REGISTRATION NUMBER XPI TION DATE E-MAIL ADDRESS
c o lEA / /I .a'c,
APPLICANT COMPANY E APPLICANT NAME
OFFICE PHONE
�-- a
�' ��i —° CITY,STATE,ZIP CELL PHOL� G NE
RELATIONSHIP TO PROJECT
o Architect o Tenant 0 Agent ❑ Other FAX NUMBER
PROJECT NAM PRIMARY PHONE (
CONTACT I ( - E-MAIL ADDRESS I
LENDER NAME' -j,..--f. _ Per RCW 19.27.095:
-� Lender information is required(f project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
(PHONE
I `
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
- Lr
CJI:CT 1 LJVZ A:uEAs
z
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
=STING PROPOSED TOTAL TOTAL EXISTING cr TOTAL PROPOSED sr TOTAL Sr
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$ (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/ShawerCombo) LAVS(Bathroom sinks( URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(roues
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 ;ederal Way as to any clai (including costs, expenses, and attorney fees incurred in the
investigation and defense of such claim), ay be made by any per including the undersigned, and filed against the city, but only
where such claim arise �tt of th reit• -ce of, e city, incl ding i if:p
and employees, upon the accuracy of th inform tion supplied to
the city as a part of is piicat n. /7 , f�
SIGNATURE: (� � t-
_ DATE 7
Pro.'rty Owner a d/or Authorized Agent
•
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 a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—January 1,2008 Page 2 of 4 k\Handouts\Pernut Application
6 ,
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-$115.50;Each add'n 500 ft2-$37.00) 0 to 100 amp $125.50 $76.50
❑ Detached outbuilding or garage ❑ 01-200 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
0 801 - 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
0 401 - 600 amp 212.50 106.00
❑ 601 -800 amp 272.00 145.50 ALTERED COMMERCIAL/INDUSTRIAL
❑ 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
Service or Feeder ❑ 601 - 1000 amp 439.00
❑ 0 to 200 amp $96.00 ❑ over 1000 amp 489.00
❑ 201 -600 amp 155.50
0 #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)
U Low Voltage U Swimming pool/hot tub $115.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $76.50
❑ Security Alarm System ❑ Additional Plan Review
13 Voice Cabling $115.00/hour
❑ Data Cabling (for modified submittals)
0 ❑ Automation Fee on all Permits .. $5.50
1.t 2500 fta-$67.50;
Each add'n 2500 ft2-$17.50) +Per WAC 296-46.910(5)(W&ti/
t
Bulletin#100-January I,2008 Page 3 of 4 k\Handouts\Permit Application
ay
Commun'tyD veopmlentServices Electrical Permi : 08-103474-00-EL
P.O.Box 9718 D•93-lo
, 7
Ph:(253)835-2607FederalWayWA Fax:(263)98063-9 835-182609 Inspection Request Line: (253) 835-3050
Project Name: QWEST DSL SITE
Project Address: 412 S 321ST PL ALL Parcel Number: 926660 0000
Project Description: Service installation at the corner of S 321st PI and 5th Avenue S into West Green
Condominiums
Owner Applicant Contractor
QWEST KEN BOBKO ELECTRIC CO INC KEN BOBKO ELECTRIC CO INC
1005 17TH ST ROOM 1570 PO BOX 7009 KENBOEC066BA( 1/1/10)
DENVER CO 80202 TACOMA WA 98406-0009 PO BOX 7009
TACOMA WA 98406-0009
Additional Permit Information
Service greater than 1000 Amps? No
Electrical Fixtures
New Service/Feeder: 0- 100 amps 1
PERMIT EXPIRES Tuesday, July 21, 2009
Permit Issued on Monday, July 21, 2008
hereby certify that the above information is correct • that the construction on the above describ-d property and
the occupancy and the` ill be i c • ce - the I s, rules and -gulations of the Sta of W hington
/it • ity of d-r ",. . �i( 406)Owner or agent: Date:
�-" //VA Z 5
DATE INSPECTORAREA AND TYPE Or INSPECTION
• . 4411kii.
' THIS CARD IS TO WAIN ON-SITE
CITY OF Pommunity Developm t Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-103474-00-EL
Owner: QWEST
Address: 412 S 321ST PL ALL
FEDERAL WAY, WA
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O UFER Ground(4295) ❑ Ditch cover(4030) ❑ Slab/Concrete Floor(4255)
Approved 14
4
>24,0-. Approved Approved to place concrete
By 6— Date'•7-0. 1 By Date 7-023. By Date
— •❑ Pool Bonding(4195) ❑ Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By . Date By Date 9 62)
❑ Feeders/Sub-panels(4045) El Rough Electrical(4225) ❑ y Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
O Final-Electrical(4055)
,--.„ Approved
f S
By Date•
)
•
•
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date