09-100085FIT. or
�2MI'�
Federal !!aysr Mr ccs ME EL PL llE ENWMAII1NITYF12t'
a:1J25 N°1AtiOII'I'II • N) UO,Cw171iiiFFF T LI C /� /^T` I O "'/�'T"-
F'F:OEWAi. WAI'. WA !M0639718 ,(/, '�j j(, {\„J! \Y(
2.53 H7.i ' 507" FAX ' 53 835 2600
u-rru•.eBrx>ft._¢ra,hrnu.�+em k� p�
Tile following is required iLn��
�fgrfo) Nelapplication will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS _. 2'} . �t C �G�� �!� SUITE/UNIT #
ASSESSOR'S TAX/PARCEL fi .__m. _ , _ _ —_ _ __ __ LOT SIZE NJ)
LEGAL DESCRIPTION (e.g. /lane is'slales, Loi 1) V � (� � � � / ii-V� �X "u
(Arfavi of -111, Ix,gr •)<rr h."191110 tay,R Ift-011 n1
PROJECT•' •
TYPE OF PERMIT C) BUILDING d PLUMBING ❑ MECHANICAL
0 DEMOLITION d ELECTRICAL D ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Proutde detuiled description o% Mork included On oris nermtf onto)
PROJECT NAME (Name of Business or (honer Last Name) �� on -Tj T—
PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
(VA411bC[ PI21MN2YI*IIONE
MA]1..I1Nt.' ADDRESS CITY• s-iA'111, 7.11' L: -MNL AIANIESS
1.7`�
COMPANY NAME�Yl R �
E EQ.C-C
AI"I,ICAN'I'NAMI•;
am-
vvi- ll, PI10NE
(2c,-, )3g8
M ILING ADDRESS
l'IY. STA
-111, Zil* (�� (� ��y
l 00��
CELL PHONE
)
CPIY OF FE.DE12AL WAY BUSINESS )ACENSP. NLIMI)I-'R
6-00- 101 (63L1-- too 6L
1:XPIHN17ON DIVI'E
FAX NUMBER
(Z53)9`4$
CONTRACTOR'S REGISTRATION "NUMBER
1�-�
� �ci
i�/) /••�, EXPIRATION DAT.
� �
E-MNLADDRr SS
tJ�t1('�-j C.t� 1 �'X t� • ' 1
J V
C:C)M'ANY NAME
APPLICANT' NAME
OFFICE PHONE
C:PIY, STATE. ZIP
PHONE
MAILING ADDRI SS
CITY S'1'A111, ZIP
fCLIA. PI LONE
l ) -
RELA'1TONSIIIPT'O14KXII-'C'i'^�
-n
FAX NUMBER
❑ Architect u Tenant I.1 Agent ❑ Other �fV\
at`
7
NAME n RQLO).l n �R12Y NIIC2[7 !:-MAR.ADDItr^.SS
NAME
Per, RCW 19.27.095:
.Lender irtformation is required (f project value exceeds $5,000
MAMING ADDRI{SS
C:PIY, STATE. ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ ° "1
SPRINKLERED BUILDING? 17 YES I:I NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? u YES t_7 NO
WATER SERVICE PROVIDER I I LAKEHAVEN Ci HIGHLINE a TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER I LAKEHA"VEN t: -i HIGHLINE o PRIVATE (SEPTIC)
,
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S , FT.
TOTAL --
SQ, FT.
BASEMENT
1= NEW r r ADDITION
1 r ALTERATION
r r REPAIR r 1 TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? iiYES i l NO
BASIC PLAN?
SECOND
it NO
ZONING DESIGNATION
T1IIRI)
CHANGE OF USE?
rl YES
NO
ADDITIONAL FLOORS (DLSCRiBF<)
UP/SEPA/SU?
l YES
DECK (I I COVERE) OR I i UNCOVISR1s'1-)7)
[PLATTED LOT? i r YES r1 NO
DEMO PERMIT REQUIRED?
GARAGE I I CARI'01'0' I I
1'1l01,09K1T- � TOM
NUMBER OF FLOOliS
I TAJ. EXISTING 8F
YOTAL 1'N0IKI M Y}'
yep L Nr
"NNW IIOIVIL S ONLY" NUMBER OF BEDROOMS — _, I:STIMKI'ED SELLING PIRICE $
indicate ratntber gj'each type gj',{C-Onrc to be itistatted or re(ocaled as part of tlIis prgjcct. I)o not. itt(,Itld(? eeisting f wttres to remain.
MECHANICAL
Value gI'Mediarvtcal btbrlr _.�._ _ _ IA COPY OF BID OR ESTIMATE MUST BE INCLUDED W177I APPLICA770N)
Alit HANDLING UNITS F.VAI'ORA'11Vi' COOLERS GAS PIPE OU•11,M'S WOODSI`OVES
Imps DANS GAS W/VMR IIEN11CHS MiSC Wescrtbe)
1301LERS FIREPLACE: INSNVI'S 11001)S (conuuerelat)
COMIItISSSoltS FURNACES RANGES
MIC:11'S GAS LOG SI;I:S REFRIG. SYSTEMS
I3A'1'llTI1NS 1„rn,i,i 1,„v,.,oml,,,1 I.AVS iiswi sud,,r URINALS MISC (IN -scribe)
IMSIIWAS111?ItS RAINWAI'I:R SYSi' VACUUM 1312EAKFRS
I)RINKING 1`011MMINS SHOWERS WA71'1;1i CLOSM'S 0r410)
ELECTRIC WAITJE IIENJIb']lS SINKS WAS[IINC, MACIIINI:S
I lotir: Is113135 SUMPS
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certVy 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 responsibilityfor compliance with local, state, orfederal laws regulating construction or environmental laws,
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, 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.
A _ e t'\ _ — t
SIGNATURE:
Owner anll/or Attihortze(l
FOR OFFICE USE ONLY
1= NEW r r ADDITION
1 r ALTERATION
r r REPAIR r 1 TENANT IMPROVEMENT
BUILDING SHELL ONLY? iiYES i l NO
BASIC PLAN?
tl YES
it NO
ZONING DESIGNATION
CHANGE OF USE?
rl YES
NO
NEW ADDRESS REQUIRED? r, YES r i NO
UP/SEPA/SU?
l YES
rI NO
[PLATTED LOT? i r YES r1 NO
DEMO PERMIT REQUIRED?
r_i YES
u NO
Btr(lc6s #tOO–January 1, 2008 Page 2 o(`4 k\111utdouts\Pcruut App(ictttion
I ELECTRICAL PERMIT INFORMATION I
RESIDENTIAL
COMMERCIAL
NEW COMMERCIALZINDUSTRIAL SERVICE
NEW RESIDENTIAL SERVICE
service or Feeder Eudi Adct'n
Q Single 1"aloily squaro
❑ 0 to 100,11111) $125.50 $76.50
(Virst I:J()() I'v- $1 1:1.50: Emit wkl'o 500 112 - $37.00)
Ll
❑ 101 - 200an)p 155.50 98,00
(Inspected Witil Service) $48.50
D 201 400 aill 1) 291.00 115.00
LJ 401 600 amp 339.50 136.00
(Inspected separately) $76.50
r, 601 800 anly, 439.00 186.00
J 801 loon a1iij) 536.50 224.50
NEW MULTI -FAMILY (I I I Rl' units 0 r moan)
Q Over 1000..joip 584.50 311.50
Service Feeder
* Up to 200 amp $1215.50 $37.00
Ll Over 600 volts surcharge, $98.00
* 201 400 amp 155.50 76.50
L) mast or meter repair $106.00
LJ 401 GOO amp 212.50 106.00
ALTERED COMMERCIAL/INDUSTRIAL
EJ GO 1 800 amp 272.00 145.50
Lj ov(.I- 800 allip 389.50 291.00
Service or Feeders
D 0 to 200 will) $125.50
ALTERED SINGLE/MULTI FAMILY
0 201 - 600 ante 291.00
LA 601 - 1000 anip 439.00
Service or Feeder
over 1000 allip 489.00
0 to 200 allip $ 96.00
201 - 600amp 155.50
❑ H of circuits to be added/altered
❑ ()V(,I- 600 allip 234.00
_r) cli*colts - $98.00: AdWo OrCURS. $7.50/ca)
L)
COMMERCIAL/INDUSTRIAL PLAN REVIEW
of vircuits to I-)(. �Idded/ajtercd
$198.00 I)ILIs 35% of Permit Fee
(IA drviffls $76,50; A(khi vIrcolts $7.50/va)
L) Servime - 1.000 amps or greater
❑ blast or nicler rej),.dr $57.50
LJ Medle,ai/E(ILi0at.lon,,ii/institLitiOlIZ11 Facility
MANUFACTURED HOMES
LJ Service or f(,(-(Icr only $76.50
L) Service and t(-c(l(,i- $125.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK
Residential/Multi-Family $67.50
Q It of service or ft-cdcrs
_
(First setwice/1'ev(ter $76.50: vachad(h) -$50,00)
Commercial/Industrial Service or Feeder A-pacity
0 0 - 100 amps $76.50
Ll im -2oomitips 98.00
L1 201 400 anifts 115.00
Q 401 600 amps 155.50
LJ over 600 amps 168.00
MISCELLANEOUS SERVICE/EQUIPMENT
LJ ol'Thermostats
ro
Lj ___ 11 of' Signs
(First -$57.50:atld*n-$17. !_
le,
(First. sign -$57.50; add'n sign $27,00/ca)
WJ Low Voltage
w Voltage
Ll Swimming pool/hot tub ................ $115,00
o )", rv, (I
Square Feet to be rved 1:ty sysWin(s)
iid(ljtloo�kl orcoll, if retpNred)
Hire Alarm ��y. -tit
0 licelliv _ V At' 111!Vslvlli
0 3
L) Yard Pole meler loops ..................... $76.50
Additional Plan Review $115.00/11our
votre C- I".
(for 111odifled subillittals)
11 Data
L1 Automation Fee on all Permits $5.50
1- 500 s
- 1
00
13tilictio#100-himi,try 1, 2008 11;tge 3 of/.I W-kiridmilAPennit Application