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05-102788 CITY or '•�`F�G ' / 9 2 7 Federal Way PERMIT Jug v F MF CO ME EL COMMUN17Y DEVELOPMENT SERVICES -,n t.. r 4 PL D E EN 33325 8T"AVENUE SOUTH•PO BOX 9718 ! .•A TD FEDERAL WAY,WA 98063-9718 ` •A P P L I C A ; ( �' / / 253-835-2607•FAX 253-835-2609 tfh www.dituotfederalway.com 'NAY I i. The ollowin. is re.uired in ormation-an inco •fete a••lication will not be acce•ted. Please •rint le.ibl (in in or ••. C IN PROPERTY INFORMATION SITE ADDRESS 7j-5 51Th `C'` �� `_ct,0 - SUITE/UNIT# ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf) LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1) (Attach separate page/lengthy legal descapnoc) ■ PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on thispermit on )1\a. �\CLE's. .v v\[_i✓ a \ 1 ^ C \�_ Y ?Veil. 'tie•J if".,hi PROJECT NAME(Name of Business or Owner Last Name) y, • PEOPLE INFORMATION PROPERTY NAM \/....\ PRIMARY PHONE I OWNER � 0- \ Ltt ( ) I MAILING A \„ CITY,STAT ,ZI - c)(4D ' \---_. a L%1-3 Wil_ ,,_ CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE , ^eenS �Nc +'��i Q4 ( � ) /� MAILING ADDRESS CITY,STATE;ZIP CELL PHONE 1 ,"-r- ,.�; G� i ( ,c?) C'r. ' - Ze ,= CITY OFA FEDERAL WAY BUSINESS LICENSE NUMBER i EXPIRATION DATE FAX NUMBER -I `i-1 11' _3 .1 t.. - B L r> /.1 fi ( ) .*1 i.,-: i CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE 7.1 APPLICANT I COMPANY NAME APPLICANT NAME OFFICE PHONE f'1 ( ) - R ADDRESS ADDRESS CITY,STATE,ZIP CELL PHONE ( ) RELATIONSHIP TO PROJECT FAX NUMBER ❑ Architect ❑Tenant ❑Agent 0 Other(Describe) ( ) - CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS LENDER Per ttCiV 19 27.095 Lender information is NAME .,ie-qu,„Oiklifprojectixdue exceeds$5,000 v-; MAILING ADDRESS CITY,STATE,ZIP . . • DETAILED BUILDING INFORMATION . EXISTING USE PROPOSED USE /J<�.---"" EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ lye t 1' SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQtJ'I•- t? 0 YES 0 NO WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) , PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ. FT. SQ. FT. SQ. FT. BASEMENT FIRST SECOND THIRD FOURTH •• ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE ❑ CARPORT❑ EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED Sr TOTAL SF 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 $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOODS(Comm<rcol) WOODSTOVES BOILERS FIREPLACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAS WATER HEATERS DUCTS _ GAS PIPE OUTLETS PLUMBING BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(-rout) MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS(Bathroom Sinks( VACUUM BREAKERS ELECTRIC WATER HEATERS DISCLAIMER/SIGNATURE BLOCK 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 incurredin 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 . . . employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE IZ � .414 ® �_` DATE > '- \ -60D (Signature) -411111111ftb, (Title) RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect 0 Other CE •ONLY W ., a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT $UILD, ING;SHELL-ONLY? a YES a NO BASIC PLAN? a YES a NO �ZONINGESIGNATION CHANGE OF USE?- a YES a NO 'LlE W . D KESS REQUIRED? a YES -a NO UP/SEPA/SU? a YES a NO It.ILm_W��1D ,.TTED LOT? _ a YES ❑NO DEMO PERMIT REQUIRED? a YES a NO Bulletin#10()—January 7,2005 Page 2 of 4 k\Handouts\Permit Application . LwECTRICAL PERMIT INFORMA ,ON RESIDENTIAL t COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE Service or Feeder Each Add'n ❑ Single Family Square Feet (First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50 ❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00 (Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00 ❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50 (Inspected separately) $69.50 ❑ 601-800 amp 398.50 168.50 ❑ 801 - 1000 amp 486.50 203.50 NEW MULTI-FAMILY(three units or more) LI Over 1000 amp 530.50 283.00 Service Feeder LI Up Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00 ❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00 ❑ 401 -600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL O 601 -800 amp 247.00 132.00 ❑ Over 800 amp 353.50 264.50 Service or Feeders ❑ 0 to 200 amp $113.50 ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50 ❑ 601 - 1000 amp 398.50 Service or Feeder ❑ over 1000 amp 443.50 ❑ 0 to 200 amp $87.00 ❑ 201 -600 amp 141.00 ❑ # of circuits to be added/altered ❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea) ❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW (1-4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Fee ❑ Service- 1,000 amps or greater LI Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility MOBILE HOMES U Service or feeder only $69.50 ❑ Service and feeder $113.50 TEMPORARY SERVICE MOBILE HOME/RV PARK Residential/Multi-Family $61.00 ❑ # of service or feeders (First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Arnpacity ❑ 0- 100 amps _ $69.50 ❑ 101-200 amps 89.00 ❑ 201-400 amps 104.50 ❑ 401-600 amps 141.00 ❑ over 600 amps 152.50 MISCELLANEOUS SERVICE/EQUIPMENT ❑ #of Thermostats ❑ #of Signs (First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea) ©'Low Voltage ❑ Swimming pool/hot tub $87.00 Square Feet to be served by system(s) T L`--1C:. (Includes additional circuit,if required) El Fire Alarm System ❑ Yard Pole meter loops $104.50 O Security Alarm System ❑ Additional Plan Review $104.50/hour O Voice Cabling (for modified submittals) ❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00 (Per System(s) 1•t 2500 ft2-$61.00; Each add'n 2500 ft2-16.00) `Per WAC 296-46-910(5)(b)(i&0) Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application