10-101365 ,,,, Ei
4 CITY OF
" ` vEtioPERMIT SF`�F CO ME EL PL DE EN` FP
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Federal Way,0
COMMUNITY
07V LOPFAX ME 8 SERVICES 0 5 2609 vvAAPPLICATION
www.atuo ederalwau.con
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SUITE/UNIT# ZONING ASSESSOR'S TAR/PAQiCEL M�
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NAME OF PROJECT . --
(Tenant
—
(Tenant or Homeowner Name) Vd I C(Cn Ory UP' F OF_4(fCvt ?1
❑ BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION g ELECTRICAL 0 ENGINEERING AIFIRE PREVENTION
(1 L
4 Cr coveme(t 5c ; Zo 't601--\. "14,s61l 3 .,.) s-n
PROJECT pESCRIPTION de4e rcS (`2 tiled-e b extSTlh� SmaKe. dei c o rete.�cc ce a k' .n I
Detailed description of work to LG�i`t ) ` -
be included on this permit only $) - 6 v ( inS k- \ 1_ i o /6 TI Ob e 2. 1 rio,i S�be .
m
-1 NAME/ 1. t f fir, G� 1 PRIMARY PHONE
' ,PROPERTYOWNER 60Ic n Slone L�.c 4CO 1 ikueS SUc9( ( ) -
QC; 'A., MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
® 1 p �c�ec�1 1,1., �.4e,, �i�6o 3
I OWNER IS ALSO: o CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHO
�� &f�htne�- -)n Aletrrn .mac,. c 6) `6-��5
MAILING ADDRESS, ITY,STATE,ZIP FAX
CONTRACTOR 053 `?. k v�, 5a*v44G .5iLitt ( )3)a- r)g etf
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Wi-\6 T- OC3 / /OS- /I I -0o-lat6ac^ l3i^
NAME / �,,+ I 1 `P�RIMMARY PHONE
APPLICANT NR‘(G11 ► 't^` (1/uo ) '-Y/lJ - 3(/(,C>"
STATX,ZIP FAX
MAILING(ISR SCITY,
• ��.Vl( �'1 , I�� e Irk I;. 4 it / ((-n) 390' /(/' /
PROJECT CONTACT NAME S PRIMARY PHONE
(The individual to receive and R'{OJf\ /` cv l (J)/ ) 3.k- 3G
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) 1253 C V r1/ ,rN St-,
,t4 L Vic, c 1/J(i( p`( �1 fV,6) 3(93- 7011/
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL II
Mark Ii\AC1-I LAZA r ( art)30(/ -a ) Cc..1 et'ky,,Srr'nciiiidarm,((vn
PROJECT FINANCING NAME
OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.2 7.095)
( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to arty claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as of this tion. _
SIGNATURE: �// DATE 1 / c l (C'
PRINT NAME: Z,,.,�� 4.,,,,,,L,—
Bulletin#100—4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(cos)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING 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.
BATHTUBS(or Tub/shower combo( LAVS(Hood Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 1 , (-('7600 $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑ Yes 0 No
RESIDENTIAL ik , . .
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT _...
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL - `.---Area Totals
**1VEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
,. e
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING '
ADDITION
;R. fir ' s, �• -&.r" z�;a'�, r� . ,:a.
OMIVIEIZ+ IAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
z �
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:Wandouts\Permit Application
I • ELECTRICAL i
RESIDENTIAL COMMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet 1st Service/Feeder Additional Feeders
(including attached garage): 0- 100 amp x$131.50 x$ 80.00
FEES: First 1300 ft2-$121.00; 101- 200 amp x$163.00 x$103.00
Each additional 500 ft2-$39.00
201 400 amp x$305.50 x$120.50
NEW MULTIFAMILY (3 units or more) 401- 600 amp x$356.00 x$14 $0
1st Service/Feeder Additional Feeders 601- 800 amp x$460.50 x$195.00
0- 200 amp x $131.50 x $ 39.00 801-1000 amp x$562.50' x$235.50
201 -400 amp x $163.00 x $ 80.00 Over 1000 amp x$613.00 x$327.00
401 -600 amp x $223:00 x $111.00
601 -800 amp x $285.50 x $152.50 Over 600 volts serge x$103.00
Over 800 amp x $408.50 x $305.50
ALTERED SINGLE or MULTI FAMILY ALTERED COMMERCIAL
1st Service/Feeder Additional Feeders 1st Service/Feeder Additional Feeders
0- 200 amp x $100.50 x $ 39.00 0- 200 amp` ,, x$131.50 x$103.00
201 -600 amp x $163.00 x $ 80.00 201- 600 amp ,x$305.50 x$142.50
Over 600 amp x $245.50 x $111.00 601-1000 amp x$460.50> x;$35;50
Over 1000 amp x$513.00 x$327.00
Added or Altered Circuits
(1-4 circuits$80.00;each additional$8.00) Added or Altered Circuits
1-5 circuits$103.00;each additional$8.00
Mast or meter repair $60.50
Mast or meter repair $111.00
MANUFACTURED HOMES PLAN REVIEW FEES
...............................
. ................................
Serves or feeder only x $ 80.00 0
$103.00 plus 35%of Permit Fee;Plan Review required for:
Service and feeder x $131.50
❑ New,or alteration to, service of 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
Plan review for modified submittals $120.50/hour
MISCELLANEOUS SERVICE/EQUIPMENT
LOW VOLTAGE TEMPORARY SERVICE
Fire Alarm sg
System 1st Service/Feeder Additional Feeders
Security Alarm System
❑ Voice/Data Cabling 0- 60 amp x $ 71.00 x $ 32.00
❑ Other 61- 100 amp x $ 80.00 x $ 39.00
Area to be served by system: AS66
101-200 amp x $103.50 x $ 51.00
Pt 2,500 ft2-$71.00;each additional 2,500 ft2-$18.50)
201-400 amp x $120.00 x $ 60.50
#of Thermostats 401-600 amp x $163.50 x $ 80.00
First$60.50;each additional$18.50
Over 600 amp x $183.00 x' $ 92.00
#of Signs **NOTE: an automation fee of$6.00 will be charged
First$60.50;each additional$28.50 on all permits**
Yard Pole/meter loops/pedestal x$ 80.00
Portable Generator(transfer equipment) x$100.50 For fixtures or fees not listed contact the Permit Center at
Ditch cover/inspection only x$120.50 253-835-2607
Bulletin#100-4/17/2009 Page 3 of 4 k:\I-Iandouts\Permit Application