12-102907 A
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CITY OF
Federal Way ELECTRICAL
RECEivt PERMIT APPLICATION
JUN 252012
**Most electrical permits may be obtained on-line at www.cityoffederalway.com**
" ,,,/�; PROPERTYINFORMATION
SITE ADDRESS:
33 Jo / '� `i"f: G
SUITE/UNIT/SPACE# ASSESSOR'S TAX/PARCEL#
_ CURRENT/PROPOSED USE
# }y '''''<`WF RMATION
PROJECT NAME
(Tenant or Homeowner Last Name) /rill F 55 /�%
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PROJECT DESCRIPTION ,i)R. 6 r u I/°/n ft:4)7 ").,,D T(/
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ��f j yF k .1-4/C- , ( )
MAILING ADDRESS E-MAIL
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CITY STATE ZIP FAX
POler44,�) a 0, I`7Ok5lz... ( ) -
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
ELECTRICAL yyj'3 Ge-•✓7'6,Q srm'cr
CONTRACTOR CITY STATE ZIP 9 f FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
(24_0✓ref 934R Y1 30 / i/-/ /'/- 7?- t,.7( ,'<''C�1-
NAME PRIMARY PHONE
APPLICANT ( )
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
( )
NAME PRIMARY PHONE
PROJECT CONTACT
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 supportof 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.
(Mitt /1
SIGNATURE: DATE t `_' P.-
PRINT
PRINT NAME: ►"l t1ja`*(3
33325 8th Avenue South•Federal Way♦WA 1 98003-6325♦253-835-2607♦fax:253-835-2609♦www.cityoffederalway.com
Bulletin#160—January 1,2011 Page 1 of 2 k:AHandouts\Electrical Permit Application
•
K
RESIDENTIAL COMMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet
(including attached garage): 1st Service/Feeder Additional Feeders
0- 100amp 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
❑ Security AlarmSystem
0 Voice/Data Cabling 0- 60 amp x $ 71.00 x $ 32.00
0 Other 61 100 ampx $ 80.50 x $ 39.00
Area to be served by system: &63 c7
1st 2,500 ft2-$71.00:each additional 2,500 ft2-$18.50 101-200 amp x $103.50 x $ 51.00
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 ampx $184.50 x $ 92.00
FEE CALCULATIONS
Yard Pole/meter loops/pedestal x$ 80.50 • Fees are determined by the scope of work as indicated.
Portable Generator(transfer equipment) x$101.00 • A$6.00 Automation Fee will be added to all permits.
Ditch cover/inspection only x$121.00 • For assistance in calculating fees or completing the
application form, contact the Permit Center at
253-835-2607
33325 8`h Avenue South•Federal Way•WA♦98003-6325♦253-835-2607 1 fax:253-835-2609 1 www.cityoffederalway.com
Bulletin#160-January 1,2011 Page 2 of 2 k:AHandouts\Electrical Permit Application
• Electrical
City of Federal Way
Community&Econ.Dev.Services Permit #: 12-102907-00-EL
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 ., Inspection Request Line: (253)835-3050
Project Name: FITNESS 19
Project Address: 33702 21ST AVE SW Suite C Parcel Number: 930100 0010
Project Description: Add/alter circuits in(2)200-amp panels for new tenant. Low-voltage A/V cabling.
Owner Applicant Contractor
FITNESS 19 CLOVER CREEK ELECTRIC CLOVER CREEK ELECTRIC
17215 SE WAX RD 1413 CENTER ST CLOVECE293LA(4/30/14)
COVINGTON WA 98042 TACOMA WA 98409 1413 CENTER ST
TACOMA WA 98409
•
Additional Permit Information
Is Use Educational or Institutional? No Service greater than 999 Amps? No
Electrical Fixtures'.
Alt.Srvc/Feeder 0 to 200 amps(C 2 Low Voltage-Other(Commercial 1
PERMIT EXPIRES Saturday, December 22, 2012
Permit Issued on Monday, June 25, 2012
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 or agent: �l/l/ Gt,�r'c-�- Date: 6/.0)-.3-// _____
.fro/iz-
' • THIS CARD IS TO MAIN ON-SITE
�,n of Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-102907-00-EL Address: 33702 21ST AVE SW Suite C
Project: FITNESS 19 FEDERAL WAY, WA 98023
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) 0 Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
O Pool Bonding(4195) 0 Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
O Feeders/Sub-panels(4045) ' ❑ Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
•By Date Bye Date `a,lvi2 \1
By (S / /2
Date9_ _
0 Final-Electrical(4055) (,
Approved
`Byckfty„xs Date IZ5 ,... _.%-l'Z- .
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date