07-106583 . R EC WE ID41)
;SEC 1 0200701 _ L6 40_, t 3..-D
co>F rs ITY OF FEDERAL Wi E�-� MIT
�U�L(71NG� � SF MF CO ME EL PL DE EN FP
33925 1RAL YL��r�PO9718 PLICATION
253135-2 WAY.WA 53835-2 O
253-�ii5.2607 FAX 253-835-2609
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Imukcituoffederaiwau.cotn
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
SITE ADDRESS 3;04* 32 AC A-.)-L. S. svlTE,u #-
ASSESSOR'S TAX/PARCEL# - -- -- LOT SIZE(s) II,00i::'SIP.
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) - Cv.r•.pvy 'fit as C--
(Math sePamlePageforlengths!ft.!desertMon)
MI PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMING 0 MECHANICAL
ff
0 DEMOLITioN, ELECTRICAL 0 ENGINEERING$FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this Permit onhi) , \\
1 rz1a.(1 . rm... A twm +i ..cvrA�t 1,"..9 Pc1-•1�!`^4-.A1_ Ra_.,j�64,..... F; . klanti,
A(a) poi ,.,t
PROJECT NAME(Name of Business or Owner Last Name, —0 2&Joe n uS-h j `,-ti
• PEOPLE EVFOR`LATION
PROPERTY
PRIMARY MIME
OWNER NAME 'EC,•51' CC^' 6" ic_ei-c.c - I-1-c- -
MAJUNGADDRESS cn,SLATE.zI E-MAIL ADDRESS
CONTRACTOR i COMPANY NAME AI'PUCANTNAME OFFICE PHONE
i3..4-.KN..,.- I . d. St,.,.)r.4,7 4,c '9 -f age:6504 D. (Zj25) 24 Ll - 1114 t"
CM.STATE.ZAP CELL PHONE
t4f:UN.a5tOr\ *4114 434622.7
OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIR&IION DATE FAX NUMBER
£1 (3(pi )"1u3 -`c° 5'
iir
�M� EMAIL ADDRESS
tif17#1177
APPIJ �N�ANY NAME APPidCANi NAME OFFICE PHONE
aryls!' Znr i 4-Sp wr;- Li-e- S� F Brrs�ssq+�r<} (itt ) 244 - wt '
MAA NG A�Ia55 cmr$ThZ ZIP cEta PHONE
I-Viol "-r L. ASS Ari;,-5rt r- r.fix 3 Nils) 24,4 - )445'
RELATIONSHIPTO PROJECT FAX NUMBER
a Architect ❑Tenant o Agent &Other Svy c fl•'• 'ado- (no) 4o3 - r70g?'
PROJECTME PIUMARY PHONE ADDRESS
CONTACT 31:f a/b55u-t (t't ) 24 9 - 1'4t1� EMAIL
N fJ.
LENDER NAME Per ROW 19.27.095:
Lender iqihnnation is required tfprrdwi t antes aooeads$5,000
MAILING ADDRESS CM,STATE.ZIP PHONE
( ) -
M DETAILED Bull DING INFORMATION
EXISTING USE 04^,.-w.4 PROPOSED USE
EXISTING ASSESSED/APPRAISEDO
VALUE$ VALUE OF PROPOSED WORK $ 3 oO.^
AGR 'AYES a NO FIRE SUPPRESSION SYSTEM PROPOSED//REQUIRED? a YES a NO
WATER SERVICE PROVIDER a LAHEHAVEN a HIGHIDTE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a IMMUNE a PRIVATE(SEPTIC)
III III
• PROJECT FLOOR AREAS
AREA DESCRIPTION E ISiir,i PROPOSED TOTAL
SQ.FT, SQ.FT. SQ.FT.
BASEMENT
44;110 --47154
FIRST
11,000 (co,0,04.>
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBES
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORSzoom
PROPOSED rarer. rericEMIsrser rosszaro oswa wS�r
aee
"NEW HOMES ONLY" NUMBER OF BEDROOMS ES1IMA1ED SELliNG PRICE $
• FIXTURES
Indicate number of each type offixture to be installed or relocated as part of this project Do not include existtngJlxtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID ORESIIMA2EMUST BEINCLUDED WIIIYAPPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBOS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS p .q
COMPRESSORS FURNACES RANGES
DULLS GAS LOG SETS REFRIG.SYSTEMS
PLUMING
BATHTUBS(ar1Wi/ShrsaierCombo) IAVS i eoomsmb, URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS mew
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE LIMBS SUMPS
SIGNATURE
I cern&under pew ofpedurg that I am the property owner or authorised agent of the property teener.I 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("Federal Wag regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of tide permit
does not remove the owner's responsibilityfirr oumptiaice with local.state.orfederal laws regulating owwtructian or enabonmental taws.
&fort ner agree to hold harmless the City of Federal Wag as to any claim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense 4-such claim),which may be made by any person.includiR9 the wsderslgnned.and Fled against the city,but only
where such claim arises s out of the reliance of the city,including its officers and empioyees,upon the accuracy of the information supplied to
the city as apart of this , .,,. ,,,
SIGNATURE . DATE Ill t OP)
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
a NEW a ADDITION a ALTERATION a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? a TES a NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO IIP/8EPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100—August 16,2007 Page 2 of 4 klHandonts\Permit Application
•
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL NEW CO�IOQ !!L/INDUSTRIAL SERVICE
CI Single Family Feet Service or Feeder EachAdd'n
(First 130011c-$111.00:Each add'n 500 its-$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 Flaeder
❑ Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50
❑ 201-400 amp 149.50 74.00 U Mast or meter repair $102.00
❑ 401-600 amp 205.00 102.00
CI 601-800 amp 262.00 140.50 ALTS OO /DIDUS'lRIAL
❑ Over 800 amp 375.50 280.50 Service or Feeders
❑ Oto 200 amp $120.50
ALTERED SINGLE/MULTI FAMILY ❑ 201-600
amp 280.50
CI601-1000 amp 423.00
Service or Feeder
CI to 200 amp $92.50 ❑ over 1000 amp 471.00
❑ 201-600 amp 149.50 ❑ #of circuits to be added/altered
over 600 amp 225.50 (1-5 circuits-$94.50:Addh circuits.$7.00%a)
Cl #of circuits to be added/altered COMIDIRCIALANDUSTRIAL PLAN REVIEW
(1-4 circuits-$74.00:Addh 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
❑Service and feeder $120.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK t $65.00
❑ #of service or feeders
(First service/feeder-$74.00:each addh-$48.00) Commerolcdfindustrial Service or Feeder Astpacigi
Cl 0-100 amps $74.00
❑ 101-200 amps 94.50
❑ 201-400 amps 111.00
❑ 401-600 amps 149.50
U over 600 amps 162.00
M/SCELLANEOUS SERVICE/EQUIPMENT
❑ #of Themsostets ❑ #of Signs
(First-$55.00:add'n-$17.00/ea) (First sign-$55.00;addn sign$26.00/ea)
Al Low Voltage ❑ Swimming pool/hot tub $111.00
Square Feet to be served by system(s) L'I SbC7 'L i t (includes additional circuit if required)
ii Fire Alarm System ❑Yard Pole meter loops $74.00
0 Security Alarm system (3 Additional Plan Review
0 Voice Cabling $111.00/hour
0 Data (for modified submittals)
0 LiAutomation Fee on all Permits .. $5.00
la 2500 ft%$65.00:
Each addh 2500 it-17.00)*Per WAC 29646-910(50M&w
Bulletin#100-August 16,2007 Page 3 of 4 kkHandoutsTermit Application