07-101531 .°
Federal Way �•G� —
COMMUNITY DEVELOPMENT SERVICES 3 ? (61 PERMIT
SF MF CO ME EL PL DE ENT))
33325 8TH AVENUE SOUTH•PO 80X 9718�^ &1PLICATION �..JJ
FEDERAL WAY,WA 98063.971 B K '-r /
253-835-2607•FAX 253-835-2609
wuru!.ci(VoI(ederalu�ail.corn �n`a(�OP4+
The following is re.aired "F,4„ klt"ton-an incom.lete a..lication will not be acce.ted. PIease .Tint le.ibly(in ink)or ty.e.
I. PROPERTY INFORMATION
SITE ADDRESS 5Q4 j 5 933(2 + S j/ "...'I /3L-/1D�(i, Z- f SUITE/UNIT# -
ASSESSOR'S TAX/PARCEL # 26, z/ c9 0 - C✓ 2_ C>7 CJ LOT SIZE(sj) if7/- /661
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 1
(Attach separate page jar lengthy legal descrlptianl
• PROJECT INFORMATION
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL D ENGINEERING)FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on(his permit only)
71-1 AE. `X�) , d r� i bir S 2i2C -4:i r S i- i P-'S - t_L _A A,'ra�-1.:1 f red- c_ci. 732Cl Pe t-5ii-1i e.HA►J(„E_ c ti-All
rc v,c$. i- 2_ N;L(�.) 960ILL LOtl-I pAT t W, L y
IN?ip=i'ililNG� 3 4L- C) �171� rh7i�IC0It-rltic., i�fcLic-ti_S To
L a b b� .4ie - Fc e__ 7-/-1,,z_ 2v,2J)o f. OF- '4 t3 )vv j�ILou ill t 0.1:,r
PROJECT NAME(Name of Business or Owner Last Name) 6-t/ti7 pi;6) e`e_PO--fa i(_�(j,, Z
a PEOPLE INFORMATION •
PROPERTY NAME,_ n _ PRIMARY PHONE
OWNER /- /-k-'b SZ.ra L_- 1c-x,.A.' (cd? .
MAILING ADDRESS I CITY.STATE,ZIP
S- �. '3 �1h 5% r- FiE DED wA t//i Li – 99042 3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
5fh tTN-Fl(l S95.7/Z-01 5 yYlAK tifraetier Robes-1– i (Z`�3) Zig - eco'J
MAILING ADDRESS CITY,STATE.ZIP T CELL PHONE
/t e� s<la h ,��'�_ell s —04 Cedi>4 t,J4 JJ , ?927 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRA'ION DATE FAX NUMBER
I - 700c06-_5--B L / Z /moi /Cts` (Z�3) 2G G�'TZ�
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
iT�Ade sy7 ,nS ;41�v pit VDI)-C r- (253 ) Z -Z CCL(
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
/1 e� {)4///1 A(J1 ,EAS- )160 1 IVA %-14-122.(' ( ) -
RELATIONSHIP TO PROJECT / FAX NUMBER
❑ Architect ❑Tenant ❑Agent i>ther(Describe) i e-cbl)4 (25'3) 926 - 072Cn
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
LEO/0 ?i4212`.) ('253) WWW - 2,0o 1 L 7 R ve S Sm I 4Lt C 04
LENDER •
r AP
4 NAME
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
/Z.ii1 P y ,
EXISTING USE /�1a��- ) PROPOSED USE Lr rrl_/c e_ 731;`i LOA
D - -}--
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 2GS��JJ,��C)
SPRINKLERED BUILDING? $YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES JNO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
I
- . .-� PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
9.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST /6 G
SECOND —
THIRD / 1
I
FOURTH
ADDITIONAL FLOORS (DESCRIBE) Ai
DECK(COVERED?) 1 —
I
GARAGE LI CARPORT Cl
E*.TmG PROPOSED TOTAL iliF, +f -a k m` -.r # ..»
NUMBER OF FLOORS � '&', ., u
**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 in Iude existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial) 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
(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS(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 casts, 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. / / t�
NAME/TITLE ../ �!_,..... ' S l�t r 1 L DATE 2 z -moi /
(Slgnatur (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent antractor 0 Architect 0 Other
r a Ss
4,170*- M Yc �at�xcr -' t 'l x., am_ 6 `. ^as4 s x,a� + r .,. g ,,i r .�w Y,�
D p '$ '' ' B iia. - "',,.;„ea. s R t :a ^ ,isirtz Wi i ,s- z ,y`. .( vy. .5 iFi''
D.,R Y.p D .r.. a ffi t°ir.H:� M i1 � ��f � 4��.;e'-*. �,�5�,"'' 'i -'!-41.:- fid. r x
.'�-4�y�, l q� u, +'«, . A .c„"..s c .. 4 l; teat x+`
,`_ ::!0,rang es �. .e v,,,=¢, :-s ;4 d ,�. I L?`5,,,a us,„a,.7 xv .. .. � » 1s,., ....° !.»,. .Y� ..-5 .;'G,,,,,,,:°g o�q f iS A ,5..
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
�SLECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
LI Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$104.50:Each add'n 500 ft2-$33.50) CI 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 30800 123.50
(Inspected separately) $69.50 ❑ 601 -800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three emits or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
Li Up to 200 amp $113.50 $33.50 Li 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
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0to200amp $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
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
Li Service or feeder only $69.50 1
❑ Service and feeder $113.50 1
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residentiai/Muiti-Family $61.00
Li #of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps 69.50
Li 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
l
❑ #of Thermostats ❑ #of Signs
First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
' t ,�4 ?2-3 (14:: ❑ Swimming pool/hot tub $87.00
art (Includes additional •circuit,if required)
;; F C3 Yard Pole meter loops $104.50
❑ Secur`-• +'='" ystem ❑ Additional PIan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00
a
y s r`.`
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Perniit Application