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ERMIT F MF CO ME EL PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH• BOX 9718 �. APPLICATION
FEDERAL WAY,WA 98066 3-9718 � . p se / if
/ oy
253-661-0115•FAX 253b614129 '`���
www.cittioffederalwag.com
The ollowin• is re.uired in ormation-an inco •fete a.•lication will not be acce.ted. Please .rint le•ibi (in ink)or .•.
PROPERTY INFORMATION .
SITE ADDRESS 53164 0 /7402 N 1 I - S.W i SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 3 2. 7 4 O J - o ( 144. 0LOT SIZE(sJ) 1F6 1159
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) H1( `` POCK)F Pkr k �.� [[
(Atittnilt separate page for lengthy legal description)
- . PROJECT INFORMATION
TYPE OF PERMIT BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
P O JEC DESCRIPTION}�, (Provide detailed de iption of worrk�include on this permit only)
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PROJECT NAME(Name of Business or Owner Last Name) C CA.R.R AK1
•
PEOPLE INFORMATION
PROPERTY N PRIMARY// fl (/�l)Q
PHONE �
OWNER A.Iv Cuk.(vc<ko (200 )
MAILING A DRESS CITY,S�^TE,ZIP
P.0. 60 c U12.8 feQe(4 LAD N7 0, ` 80,2.3
CONTRACTOR CO PANY NAME APPLICANT NAME OFFICE PHONE
"i h,'c C't• 004-trItit- ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMB ER
— _ B L I / ( )
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application( EXPIRATION DATE
I /
e..
APPLICANT COMPANY NAME AP IC(ANNTTTNN\AME OFFICE PHONE nJ `X
MAILING ADDRESS `� `' idt k� (-46 ) 7 -292 V
C TY,STATE,ZIP 3')" CELL PHONE
P0 . 30�c .31a$ ' eder�t W7,(4.) ,(\.OOI (a0( ) 2-2q- - 2`726
RELATIONSHIP TO PRO) CT FAX NUMBER
❑ Architect ❑ Tenant ❑Agent ❑ Other (Describe) O(-O).N (2s3 )33�f - LII5 /J/
CONTACT NAMC. PRIMARY PHONE E-MAILADDRESS
k N at(k 4),) (2.66 ) z,q- -
T1�
aclza-
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP —
DETAILED BUILDING INFORMATION
.
EXISTING USE VAC_AL t Lbi- PROPOSED USE c[1031e 1'00,1 0 I }NC-e
EXISTING ASSESSED/APPRAISED VALUE $ 75:o •f VALUE OF PROPOSED WORK $ ?.540a-
SPRINKLERED BUILDING? 0 YES ' N0 FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 14CNO
WATER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE X TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER X LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
r • •
4r.� ..
PROJECT FLOOR AREAS
AREA DESCRIPTION , EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?) i;1( 0GARAGE/CARPORT t(^ 111 (71
0.9
HOW MANY FLOORS? TOTAL EwsrDvc TOTAL PROPOSED TOTAL ER!STING AND PROPOSED
`*NEW HOMES ONLY`* NUMBER OF BEDROOMS 3 ESTIMATED SELLING PRICE $ 412.5;i000,
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 S$0 D
Value of Mechanical Work $
I AIR HANDLING UNITS EVAPORATIVE COOLERS I GAS LOGS REFRIG.SYSTEMS
BBQS 6 FANS HOODS(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS # RANGES MISC(Describe)
COMPRESSORS I FURNACES ( GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
.. BATHTUBS or Tub/ShoworCombo) SHOWERS 3 WATER CLOSETS(toilet) MISC(Describe)
( DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
1 WASHING MACHINES URINALS 3 HOSE BIBBS
i- 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 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. �j �`�L,�
NAME/TITLE `,�� JIal.friA4-,, 0,1{Jl'ly'l DATE 6. A [ ' 0
(Si_ atur (Title)
RELATIONSHIP TO PROJECT Owner 0 Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
X NEW a ADDITION a ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ib!NO- BASIC PLAN? ❑YES bi(NO
ZONING DESIGNATION Q S— 7.2 CHANGE OF USE? a YES 1KNO
NEW ADDRESS REQUIRED? WiYES o NO UP/SEPA/SU? a YES a NO
PLATTED LOT? t�TES o NO DEMO PERMIT REQUIRED? o YES X NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Perniit Application
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ELi,.:TRICAL PE-'' ORMATI IT
RESIDENTIAL COMMERCIAL ° nci
NEW RESIDENTIAL SERVICE/ NEW COMMERCIAL/INDUSTRIAL SERVICE
3
" Single Family Square Feet 34'.2-
`PService or Feeder Each Add'n
(First 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) 0 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage U 101 -200 amp 117.50 74.00
(Inspected with service) $36.50 ❑ 201-400 amp 220.50 87.00
❑ Detached outbuilding or garage ❑ 401-600 amp 256.50 103.00
(Inspected separately) $58.00 ❑ 601 -800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) ❑ 801 1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
❑ 201 -400 amp 117.50 58.00 ❑ Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
❑ 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY U 0 to 200 amp $ 94.50
❑ 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 ❑ #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ # of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
$74.00 plus 35%of Permit Fee
❑ Mast or meter repair $43.50 ❑ Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
U Service or feeder only $58.00 TEMPORARY SERVICE
U Service and feeder $94.50
Commercial Residential
MOBILE HOME/RV PARK U 0- 100 $58.00 $51.00
❑ #of service or feeders ❑ 101 -200 74.00 51.00
(First service/feeder-$58.00;each add'n-$37.50) U 201 -400 87.00 n/a
❑ 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats U #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
U Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System ❑ Yard Pole meter loops $58.00
❑ Security Alarm System ❑ Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
El Data Cabling
0
(Per System(s) 1• 2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) 'Per WAC 296-46-910(5)(6)(,&ii)
Bulletin 14100-March 30,2004 Page 3 of 4 k\Handouts-Revised\Pensiit Application