13-102928CITY OF V:&�'
Federal Way
PERMIT NumsER _
0 ELECTRICAL
PERMIT APPL&VAT*N
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SITE ADDRESS:SUITE/UNIT/S
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PROJECT VALUATION
ASSESSOR'S TAX/PARCEL t
CURRENT/PROPOSED USE
PROJECT NAME
(Tenant or Homeowner Last Name)
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
-
MAILING ADDRESS
E -MAH.
CITY
STATE
ZIP
( FAX
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ELECTRICAL
CONTRACTOR
NAME�,
�1ec_-F-U C_
PRIMARY PHONE
( ) -
MAILING ADDRESS
I
E -MAH.
C
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STATE
zw
FAX
( ) -
WA STATE CONTRACTOR'S LICENSE 1 EXPIRATION DATE
Nom
FEDERAL WAY BUSINESS LICENSE N
APPLICANT
NAME
PRIMARY PHONE
( )
MAILING ADDRESS
E -MAH.
Cm
STATE
ZIP
// FAX
1 ) -
PROJECT CONTACT
NAME
PRIMARY PHONE
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 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 cl�es ot,4 pf the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t ity ajeof this application.
SIGNATURE:
PRINT NAME:
-,)- /SCJ
Bulletin IN 160 — January 1, 2013 Page 1 of 2 k:\Handouts\Electrical Permit Application
ELECTRICAL PERMIT FEES
Electrical permit fees are calculated based on the value of the electrical work to be
performed using the table below.
A copy of a contractor's bid or estimate may be required for verification of the valuation
provided. The Building Official has the authority to assign a project valuation when the
cost information provided is not consistent with industry standards.
An Automation Fee of $20.00 is also charged on each permit.
-� Plan review fees, when required, are in addition to permit fees, based on 65% of the electrical
permit fee
Plan Review is required only for:
• New, or alteration to, service of 1,000 amps or greater
• Medical/Educational/Institutional Facility
• Commercial generator installation
• Inordinately complex projects, as determined by the Building Official
TOTAL PROJECT VALUATION
INCREMENTAL FEE FACTOR
(1) $1.00 to $500.00
(1) $36.00
(2) $501.00 to $2,000.00
(2) $36.00 for the first $500.00 plus $4.50 for each additional $100.00 or fraction thereof, to and
including $2,000.00
(3) $2,001.00 to $25,000.00
(3) $103.50 for the first.$2,000.00 plus $21.50 for each additional $1.000.00 or fraction thereof, to
and including $25,000.00
(4) $25,001.00 to $50,000.00
(4) $598.00 for the first $25,000.00 plus $15.50 for each additional $1.000.00 or fraction thereof, to
and including $50,000.00
(5) $50,001.00 to $100,000.00
(5) $985.50 for the first $50,000.00 plus $10.50 /breach additional $1.000.00 or fraction thereof, to
and including $100,000.00
(6) $100,001.00 to $500,000.00
(6) $1,510.50 for the first $100,000.00 plus $8.50 for each additional $1.000.00 or fraction thereof,
to and including $500,000.00
(7) $500,001.00 to $1,000,000.00
(7) $4,910.50 for the fist $500,000.00 plus $7.00 for each additional $1.000.00 or fraction thereof, to
and including $1,000,000.00
(8) $1,000,001.00 and up
(8) $8,410.50 for the first $1,000,000.00 plus $5.50 for each additional $1.000.00 or fraction thereof.
Table A
"Many Electrical Permits can be applied for using our on-line system.
Visit cityoffederalway.com for more information."
PERMIT CENTER
33325 8th Avenue S
Federal Way, WA 98003-6325
253-835-2607 • FAX 253-835-2609
permitcenter(a�cityoffederalwa
Bulletin # 160 —January 1, 2013 Page 2 of 2 k:\Handouts\Electrical Permit Application