02-103391V
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mCity of Feueral Way Plumbing Permit #: 02 - 103391- 00 - PL
omimity Deveiopment Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: BJORK
Project Address: 28612 26TH S Parcel Number: 746690 0270
Project Description: PL - Adding bathtub, toilet, and sink to existing room
Owner
Applicant
Contractor
Jack G & Harriet J Bjork
Jack G & Harriet J Biork
NONE
3002 43RD ST NE
3002 43RD ST NE
TACOMA WA
TACOMA WA
98422-2368
98422-2368
Plumbing Fixtures
ntt .
,escr�ption _ tua _ t,
B htubs � 1 Lavatories
PERMIT EXPIRES February 3, 2003, IF NO WORK IS STARTED.
Permit issued on August 7 2002
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use w' 1 be accordance with the laws, rules and regulations of the State of Washington and
the City of Federal ��
Owner or agent:
Date:
CONSTRAkJON PERMIT APPLICATION
APPLICATION NUMBER: Q - Q 3 L - —
PPLICATIONNUMBER: -_-__
CITY FEDeRALN Y APPLICATION NUMBER:—
**The f owing is required information- Please print (in ink) or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
SITE ADDRESS:
ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT (This application): ❑ BUILDING PLUMBING ❑ MECHANICAL ❑ DEMOLITION
ELECTRICAL ❑ ENGINEERING❑ FIRE P ENT O SYSTEM-
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PROJECT ES RIPTION (Provide detailed description)/:y /GttG2 L�lf lu'yj
11W /
PROJECT NAME:
PROPERTY OWNER: NAME: DAYTIME PHONE:
MAILINg ADDRESS (STREET ADD RFSS' CITY. ST ZIP): -
CONTRACTOR:
APPLICANT:
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
EXPIRATION DATE:
(copy of card required)
NAMED: DAYTIME PHONE:
J: f� �[)
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER ( DESCRIBE): ( -
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
PROPOSED USE:
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN
PROPOSED VALUATION FOR IMPROVEMENTS:
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES . ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
0 HIGHLINE ❑ PRIVATE (SEPTIC)
Ak A11111&
**NEW RESIDENTIAL CONSTRUCTION Y** 11111111F W`
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE:
■ PROTECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT _
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTORS)
Indicate nu/nb-e'r of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) _
FAN(S) _
FIREPLACEINSERT(S) _
FURNACE(S)
GAS PIPE OUTLET(S)
PLUMBING
LAVATORY(S)
RAIN WATER SYS.
SHOWER(S)
SINKS)
SUMP(S)
GAS LOG(S) REFRIG. SYSTEM(S)
HOOD(S) WOODSTOVE(S)
RANGE(S) MISC. ( )
HEAT SOURCE: ❑ ELECTRIC ❑ GAS
URINAL(S) WATER HEATER(S)
VACUUM BREAKER(S) ElELECTRIC ❑ GAS
WASH MACHINE OUTLET
WATER CLOSET(S) MISC. ( )
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: 7 DATE:bt
PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
COMMUNITY DEVELOPMENT SERVICES • 33530 FIRST WAY SOUTH • PO BOX 9718 • FEDERAL WAY, WA 98063-9718 • 253-661-4000 • FAX: 253-661-4129
www.dtyoffederalway.com
TABLE B
NEW RESIDENTIAL SERVICES
MOBILE HOMES
MISC EQUIPMENT/TEMP SERVICES
Family _
_ Service or feeder only .........................
$50.00
_ # of Thermostats (First -$37.50; add'n-$1 1.50ea)
-Single
(First 1300 ft' -$75.00; Each add'n 500 W424.00)
_ Service and feeder ...............................
$81.00
_ # of Low voltage fire or burglar alarms
Square Feet:
First 2500 ft2443.50; Each add'n 2500 ft' -$11.50
Each outbuilding or garage ...........................
$31.00
MOBILE HOME/RV PARK
Square Feet:
(Inspected with service)
_ # of service or feeders
' Per WAC 29646-910(5)(b)(i & ii)
_ Each outbuilding or garage ...........................
$50.00
(First service/feeder-$50.00; Add'n service/
_ # of Signs (First sign -$37.50; add'n sign
(Inspected separately)
feeder -$32 each)
$17.50 each)
_ Swimming pool, hot tub, spa...............$75.00
_ Yard Pole meter loops .........................$50.00
NEW MULTI -FAMILY
COMMERCIAL/INDUSTRIAL
COMMERCIAL/INDUSTRIAL
(Includes three units or more)
Altered Service or Feeders
Service
Feeder
Amps Service or
Add'n
_ 0 to 200 ..............................................$ 81.00
_ Up to 200 amp .............. $ 81.00................
$ 24.00
Feeder
_ 201-600 .............................................. 189.00
_ 201 - 400 amp ................ 101.00....................
50.00
_ 0 to 100.........................$ 81.00.......
$ 50.00
_ 601-1000 ............................................ 284.50
401 - 600 amp ................ 138.00....................
68.50
_ 101-200 ................ ....... 101.00...........
63.50
_ over 1000.............................................317.00
_ 601 - 800 amp ................ 176.50....................
94.50
_ 201-400 ........................ 189.00...........
75.00
_ # of circuits
-Over 800 amp... .............. 252.50..................
189.00
_ 401-600 ........................ 220.50...........
88.50
(1-5 circuits -$63.50; Add'n circuits, $5 ea)
ALTERED SINGLE/MULTI FAMILY
_ 601-800 ........................ 284.50.........
120.50
(When inspected separately from the services.)
_ 801-1000 ...................... 348.00.........
145.50
TEMPORARY SERVICE
Service or Feeder
_ Over 1000 ...................... 379.00.........
202.50
Residential/Multi-Family/Commercial/Industrial
0 to 200 amp ...............................................
$ 68.50
_ Over 600 volts surcharge ......................
63.50
_0_100 ................................................ $ 50.00
-201 - 600 amp ......................................:.......
101.00
..............................
_ Mast or meter repair..............
68.50 68.50
101-200 ................................................ 63.50
_
over 600 amp ................................................
151.50
_ 201 -400 ..................................... .......... 75.00
_ Mast or meter repair .......................................
37.50
_ 401-600 .............................................. 101.00
_ # of circuits
_ over 600 ...............................................109.00
(14 circuits -$50.00; Add'n circuits $5 ea)
1t a new or aiterea commercial service is zuu amps or greater, or a new or altered residential service IS greater than 4uu amps, a plan review is required. Fee is 351/. of
permit fee +$63.50. Add'I plan review for other submissions is $75.00/hr.
FIXTURE <DESCRIPTION '(A) I FIXTURE FEE -FROM -TABLE B"(B) I NUMBER OF UNITS (C) I TOTAL (D) s - I
� Estimated Permit Fee:
\
Estimated Plan Review Fee: $63.50 +
Estimated Permit Fee: (1
Bond Amount: (15)
Estimated Permit Fee: (16)
Bond Amount: (17)
Mitigation Fee: (18) _
SBCC Surcharge: (19)
Total Column (D)
Permit Fee from line 12
X .35) = (13)
(20) (22)
(21) (23)
Total (rages one &Two): e(S)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24
Bulletin #100 - February 19, 2002