07-103747 .. \- t
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$ i CITY OF ! O 1.` _ i /
Federal Way 1 — -� Z
,+ 1ERMIT
�° ,e,..?P' SF MF CO ME EL PL DE EN®
COMM[1NITYDEVELOPMENT SERVICES
33325 8TH AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,FAX
98063-9718 0� pLICATION TD
253-835-2607•FAX 253-835-2609
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The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
,• PROPERTY INFORMATION
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SITE ADDRESS .7 35/7 9'`4
2 ,, S At', 4 - #
ASSESSOR'S TAX/PARCEL# 9 2 (O S 0 C) - 0 0 7 0 LOT SIE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRI�P,({IT�ION(Provide detailed description of work included on this permit onlu)
-LT. �[ ,t4( - / /tio, /., 7/
4� � G7vl T � i-`c`�G�.r�')G G..'�".) J.'') "� 'e X [.I7,�?� L c^.I�� f ..I� "(.1�.
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PROJECT NAME(Name of Business or Owner Last Name) -6-11r/7/ EJ bdo Too- "
"taw
MI PEOPLE INFORMATION "' •C.�/!
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
CON..' • ' •OR COMPANY NAME APPLI NAME /� OFFICE PHONE
OR E' s t4Are-{,4/fee-,1. 1.1(.. 7 e (, l/It i/I�j (2JT ) 24,-/ - 370 7
s\s/
/� MAILING ADDRESS CITY,STATE, ,,i CELL PHONE
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Po a.Fl 73 f 22:7
PviyG/i ip, l,.i If 9S 37-) ( 213 ) -6,of 7
r\ CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
n 2-o-05-1033$ ( -0°- 3L 12,131/2- -7 (kr;) 2 ( - 371(1
CONTRACTOR'S REGISTRATION NUMBER E-MAIL ADDRESS
COPY o[.*. d required _ EXPIRATION DATE
with each application [a/s.6)
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v( /� 3 Q2 I /2`I /2,0 ,fi' j e-Ff'ce zr yS leMf,4.Pc ,c aA,
APPLICANT COMPANY NAME OFFICE PHONE
E w ve i sy.rleA1-r, c �s��. Cid,w,� ( i-c3 ) 2S� 3707
MAILIN ADDRESS CELL PHONE
Po 13.°Y3�221 Pv<yc,(r4/, - /e373 (` f ) 6 K6 - 6,o, 7
RELATIONSHIP TO PROJECT4 FAX NUMBER
0 Architect ❑Tenant 0 Agent XOther yew ad#4)-4-4F,14/41/9/;. (IS3)7k+7 - 3'7/i.,
PROJECT NAME / G PRIMARY PHONE
CONTACT '€ l.i (4�_ (7�-3 ) ‘t( - t0 0�.� E-MAILE-MAILADDREss
f e
LENDER NAME] Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
oe
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 55-Di
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
.
F IN PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
BASEMENT SQ.FT. SQ.FT. SQ.FT.
FIRST
SECOND 2, ---7 21.E O 2�-72 v
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
■ FIXTURES
Indicate number of each type offixture 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/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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. /�
NAME/TITLE /v (/Clet ...t . e.t?/1.e� fri ti( ei A°t�.G/- DATE 7/..� t/07
ture)RELATIONSHIP Tjina
PROJECT ❑ Owner ❑Agent ❑ Contractor ❑Architect ❑ Other
,FOR OCE u'ONLY -J
❑NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? u YES ❑NO BASIC PLAN? a YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES n NO UP/SEPA/SU? ❑YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? u YES ❑NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application
• •
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-$111.00;Each add'n 500 ft2-$35.50) ❑ 0 to 100 amp $120.50 $74.00
❑ Detached outbuilding or garage ❑ 101-200 amp 149.50 94.50
(Inspected with service) $47.00 ❑ 201-400 amp 280.00 111.00
❑ Detached outbuilding or garage ❑ 401-600 amp 327.00 131.00
(Inspected separately) $74.00 ❑ 601-800 amp 423.00 179.00
O 801 - 1000 amp 516.50 216.00
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 563.00 300.00
Service Feeder
❑ Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50
❑ 201 -400 amp 149.50 74.00 ❑ Mast or meter repair $102.00
U 401 -600 amp 205.00 102.00
U 601 800 amp 262.00 140.50 ALTERED COMMERCIAL/INDUSTRIAL
U Over 800 amp 375.50 280.50 Service or Feeders
❑ 0 to 200 amp $120.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 280.50
❑ 601 - 1000 amp 423.00
Service or Feeder
❑ over 1000 amp 471.00
U 0 to 200 amp $92.50
U 201 -600 amp 149.50 ❑ #of circuits to be added/altered
❑ over 600 amp 225.50 (1-5 circuits-$94.50;Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$74.00;Add'n circuits$7.00/ea) $94.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $55.00 ❑ Medical/Educational/Institutional Facility
MANUFACTURED HOMES
❑ Service or feeder only $74.00
U Service and feeder $120.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $65.00
❑ #of service or feeders
(First service/feeder-$74.00;each add'n-$48.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps $74.00
❑ 101-200 amps 94.50
❑ 201-400 amps 111.00
❑ 401-600 amps 149.50
❑ over 600 amps 162.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats U #of Signs
(First-$55.00;add'n-$17.00/ea) (First sign-$55.00;add'n sign$26.00/ea)
❑ Low Voltage U Swimming pool/hot tub $111.00
Square Feet to be served by system(s) -i 12 (Includes additional circuit,if required)
RkFire Alarm System U Yard Pole meter loops $74.00
D Security Alarm System
U Additional Plan Review
❑ Voice Cabling $111.00/hour
❑ Data Cabling (for modified submittals)
❑ U Automation Fee on all Permits .. $5.00
1st 2500 92465.00;
Each add'n 2500 92-17.00) x Per WAC 296-46-91o(5)(blf&10
Bulletin#100-April 2,2007 Page 3 of 4 k\Handouts\Permit Application