10-102939 •
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City of Federal Way • •Electrical
Community Development Services Permit #: 10-102939-00-EL
P.O.Box 9718
Federal Way,WA 98063-9718 ec
Ins tion Request Line: (253) 835-3050
Ph:(253)835-2607 Fax (253)835-2609 p q
Project Name: NORTHWEST SPINE CLINIC
Project Address: 35002 PACIFIC HWY S Suite A105 Parcel Number: 185295 0050
Project Description: Alter up to(5) circuits for tenant improvements.
Owner Applicant Contractor
FEDERAL WAY CROSSINGS M C SIGNS&BANNERS M C SIGNS&BANNERS
1621 114TH AVE SE SUITE 132 14107 PIONEER WAY E SUITE B MCSIGSB911P3(10/23/11)
BELLEVUE WA 98004 PUYALLUP WA 98444 14107 PIONEER WAY E SUITE B
PUYALLUP WA 98444
Ad difl;Permit lrtforma#[c[Yifmt
,
Is Use Educational or Institutional? No Service greater than 999 Amps? No
Circuits-Commercial 5
PERMIT EXPIRES Tuesday, July 12, 2011
Permit Issued on Monday, July 12, 2010
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner oragent: ��� i� Date: /72—//—
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F1NALED g
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' r THIS CARD 1S TO REMAIN ON-SITE
F,T.OF
Federal Way • Construction Insection Record
INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 10-102939-00-EL Address: 35002 PACIFIC HWY S Suite A105
Owner: FEDERAL WAY CROSSINGS FEDERAL WAY, WA 98003
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.
0 UFER Ground (4295) 0 Ditch cover(4030) El Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
El Pool Bonding(4195) 0 Temporary Power(4275) ❑ Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) 0 Rough Electrical (4225) ❑ Ceiling Cover(4020)
Approved Approved Approved
By Date B3(5 Date 7_ /4,... / By Date
•0 Fin l-Electrical(4055)
Approved
By Date t'-
LI Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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CITY OF Aojeol v ( 0
Federal Ways ELECTRICAL 7-
.0\-- tkPP`! MIT APPLICATION
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*Most electrical permits may be obtained on-line at www.cityoffederalway.corn**
PROPERTY INFORMATION
SITE ADDRESS: _
SUITE/UNIT/SPACE# ASSESSOR'S TA8/PARCEL# wy, s `,LNA"-ic-' CURRENT/PROPOSED USE
PROJECT INFORMATION
PROJECT NAME l , I ,^ 1
(Tenant or Homeowner Last Name) P t;i ,� IA �� ,�, ' �/ /" O Q F/'(s� _ ���C
Adel l✓ -�j 5lt i �heS 44S- Pitt.� S -f- 1el wYtn exs/Slgj
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PROJECT DESCRIPTION LA; I r e jJ +1.-,a.--1- r.5 1•c Cwt.5;-0,3 7y o rn C e/11,5 -
Detailed description of work to
be included on this permit only
PEOPLE
NAME PRIMARY PHONE
PROPERTY OWNER Pecks c I ;it( (110S;.; ,1e'5 ( ) -
MAILING ADDRESS E-MAIL
/(41 I,(J j /14"` „ fT 5",-1e4132- -
CITY STATE ZIP FAX
? -j 1 ekt� WA 9' e''1 ( ) -
NAME PRIMARY PHONE
MLR PIS (CS3) 7- ?--'
MAILING ADDE-MAIL
ELECTRICAL l L/107 i i,r pe,( (,,//�]}( -, .4(, ; :tiliea ri LSi k 6iin c., „Li.
CONTRACTOR C STATE ZIP F
WHSTt (CONTRA R'8 LICENSE# V U, q K 3 7 2-EXPIRATION TE (z cFEDER )64/.3--AY 7 cl y 6SE N
NAME , PRIMARY PHONE
APPLICANT --x T�, Qn�(L< L C ( )
MAILING ADDRESS E-MAIL
4c� 5� 2c R T
CITY STATE ZIP FAX
- ,+- V/+ "dC t ( ) -
NAME PRIMARY PHONE
PROJECT CONTACT � ( )35-3- 7X LPC
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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 part of this application.
SIGNATURE: e�� . DATE 7//21�/o
PRINT NAME:
33325 811'Avenue South•PO Box 9718•Federal Way•WA♦98063-9718•253-835-2607♦fax:253-835-2609 1 www.cityoffederalway.com
Bulletin#160—April 9,2010 Page 1 of 2 k:\Handouts\Electrical Permit Application
AlIlk
RESIDENTIA• CAMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet 1st Service/Feeder Additional Feeders
(including attached garage): 0- 100 amp x$132.50 x$ 80.50
FEES: First 1300 ft2-$122.00; 101 - 200 amp x$164.00 x$103.50
Each additional 500 ft2-$39.00
201- 400 amp x$307.00 x$121.00
NEW MULTIFAMILY (3 units or more) 401- 600 amp x$358.00 x$143.50
1st Service/Feeder Additional Feeders 601- 800 amp x$463.00 x$196.00
0- 200 amp x $132.50 x $ 39.00 801- 1000 amp x$565.00 x$236.50
201 -400 amp x $164.00 x $ 80.50 Over 1000 amp x$616.00 x$328.50
401 -600 amp x $224.00 x $111.50
601 -800 amp x $287.00 x $153.50 Over 600 volts surcharge x$103.50
Over 800 amp x $410.50 x $307.00
ALTERED SINGLE or MULTI FAMILY ALTERED COMMERCIAL
1st Service/Feeder 1st Service/Feeder Additional Feeders
0- 200 amp x $101.00 0- 200 amp x$132.50 x$103.50
201 600 amp x $164.00 201- 600 amp x$307.00 x$121.00
Over 600 amp x $246.50 601 - 1000 amp x$463.00 x$196.00
Over 1000 amp x$515.50 x$328.50
Added or Altered Circuits .
1-4 circuits$80.50;each additional$8.00 Added or Altered Circuits
1-5 circuits$103.50;each additional$8.00
Mast or meter repair $60.50
Mast or meter repair $111.50
MANUFACTURED HOMES PLAN REVIEW FEES
Service or feeder only x $ 80.50 Plan Review required only for:
Service and feeder x $132.50
• New, or alteration to, service of 1,000 amps or greater
• Medical/Educational/Institutional Facility
$103.50 plus 35%of Permit Fee
(Permit Fee x 35%= +$103.50=Plan Review Fee)
Plan review for modified submittals $105.50/hour
MISCELLANEOUS SERVICE/EQUIPMENT
LOW VOLTAGE TEMPORARY SERVICE
❑ Fire Alarm System 1st Service/Feeder Additional Feeders
0 Security Alarm System
❑ Voice/Data Cabling 0- 60 amp x $ 71.00 x $ 32.00
❑ Other 61 - 100 amp x $ 80.50 x $ 39.00
Area to be served by system:
101 -200 amp x $103.50 x $ 51.00
l""2,500 ft2-$71.00;each additional 2,500 ft2-$18.50
201 -400 amp x $121.00 x $ 60.50
#of Thermostats 401 -600 amp x $164.00 x $ 80.50
First$60.50; each additional$18.50
Over 600 amp x $184.50 x $ 92.00
#of Signs FEE CALCULATIONS
First$60.50; each additional$28.50 • Fees are determined by the scope of work as indicated.
Yard Pole/meter loops/pedestal x$ 80.50 • A$6.00 Automation Fee will be added to all permits.
• For assistance in calculating fees or completing the
Portable Generator (transfer equipment) x$101.00 application form,contact the Permit Center at
Ditch cover/inspection only x$121.00 253-835-2607
33325 8'h Avenue South♦PO Box 9718♦Federal Way♦WA♦98063-9718♦253-835-2607♦fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160-April 9,2010 Page 2 of 2 k:AHandouts\Electrical Permit Application