09-1040777CO
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Federal �ETVECGPERMIT
ELPMEN-1 1533 092538352D4E� AP P LI CAT I OCOMMUMY60VON �� S
www. cituolfederalwati. corn
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-7777,
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PROPERTY
SITE ADDRESS
H c1 S 33'G+'^ �Q�63
SUITE/UNIT # ZONING ASS SOR'S TAX/PARCEL # 2-0
ZRo
-
t,�., ..
NAME OF PROJECT
(Tenant or Homeowner Name) CP►'20(_ r,) TL►2S2.AC L�"
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION El ELECTRICAL ❑ ENGINEERINGA FIRE PREVENTION
��2� 1 Qv� � ►JAZ �l..- 1ACv
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PEOPLE
NAME PRIMARY PHONE
PROPERTY OWNER ARPt-rP 't-� �'�q ( ) -
MAILING ADDRESS, CITY, STATE, ZIP E-MAIL
L41A &Ou S
OWNER IS ALSO: ❑ CONTRACTOR APPLICANT PROJECT CONTACT
NAME PRIMARY PHONE
CONTRACTOR MAILING ADDRESS, CITY, STATE, ZIP FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE #
FI2(S-5w) 1 12 /2,i /Z)9
NAME PRIMARY PHONE
APPLICANT JFIZ(_5— S S hf T (LS3 )%33 -RLIV
MAILING ADDRFA, CITY, STATE, ZIP FAX
_ 2M e� R� . N • ��c'��� �►.,c, 5�0 1 (2r3 )7 3.6`- oll�
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and 0 1_o (ZSR ) 1- la 7_9 w
respond to all correspondence MAILING ADDRESS, CITY, STATE, ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
OWNER -FINANCED
Required for projects with
value of $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP PRIMARY PHONE
(RCW 19.27.095) ( )
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 f led against the
city, but only where such claim arises out of the reliance of the c' , including its officers and employees, upon the accuracy of the
information supplied to the city as a p of th' a ication. f'
SIGNATURE: DATE
PRINT NAME:_AlArzZ
13ulletin#100-4/21/2009 Page 1 of k:U3andouts\PermitApplication
GENERAL INFORMATION
MECHANICAL FIXTURES
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type offixture to
be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (Commercial)
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
GENERAL INFORMATION
PLUMBING
FIXTURES
Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing jixtures to remain.
BATHTUBS (or7Lb/shower Combo)
LAVS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitch—mwity)
WATER HEATERS (Etectrlc)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
$ 44 ,560
Additional Information
NEW BUMDING
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTALFOR OFFICE USE
-............
...................................................
_..............
_...__.._...
_.............................
__...._..._.._.._.......
BASEMENT
.......... ........ .................................................. ................... _............ _........................ _.................. _.............. _... .................
.
FIRST FLOOR (or Mobile Horne)
................... .... ... ............................................................ -_......... _........... _.._............. _._.................. __._.................
SECOND FLOOR
............ ............... .................._.._......... _............ _................... .... _._..................................... ...........
.........................
COVERED ENTRY
......................... ----.._................. _..... _.......... _..---..............................................................................
DECK
GARAGE ❑ CARPORT ❑
..... .... .._._....... _.__....... _............................................ _............................................................................ _...................
OTHER (describe)
- ._...._...-----._._.._._..__........._............_.__... _................................................. I .......... I...............
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY*"
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUMDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AjzEA ONLY
PROJECT AREA ONLY
Bulletin #100 - 4/21/2009 Page 2 of 4 k:AHandoutsTermit Application
• ELECTRICAL 0
RESIDENTIAL
COMMERCIAL
NEW SINGLE FAMILY RESIDENCE
NEW COMMERCIAL
Total Square Feet
1,11 Service/Feeder Additional Feeders
(including attached garage):
0 - 100 amp x $131.50 x $ 80.00
FEES: First 1300 W - $121.00;
101 - 200 amp x $163.00 x $103.00
Each additional 500 W - $39.00
201 - 400 amp x $305.50 x $120.50
401 - 600 amp x $356.00 x $142.50
NEW MULTIFAMILY (3 units or more)
1 s' Service/Feeder Additional Feeders
601 - 800 amp x $460.50 x $195.00
0 - 200 amp x $131.50 x $ 39.00
801 - 1000 amp x $562.50 x $235.50
201 400 amp x $163.00 x $ 80.00
Over 1000 amp x $613.00 x $327.00
401 600 amp x $223.00 x $111.00
601 800 amp x $285.50 x $152.50
Over 600 volts surcharge x $103.00
Over 800 amp x $408.50 x $305.50
ALTERED SINGLE or MULTI FAMILY
ALTERED COMMERCIAL
1s' Service/Feeder Additional Feeders
1s' Service/Feeder Additional Feeders
0 - 200 amp x $131.50 x $103.00
0 - 200 amp x $100.50 x $ 39.00
201 - 600 amp x $163.00 x $ 80.00
201 - 600 amp x $305.50 x $142.50
Over 600 amp x $245.50 x $111.00
601 - 1000 amp x $460.50 x $235.50
Over 1000 amp x $513.00 x $327.00
Added or Altered Circuits
1-4 circuits $80.00; each additional $8.00
Added or Altered Circuits
1-5 circuits $103.00; each additional $8.00
Mast or meter repair $60.50
Mast or meter repair $111.00
MANUFACTURED HOMES
PLAN REVIEW FEES
Service or feeder only x $ 80.00
$103.00 plus 35% of Permit Fee; Plan Review required for:
Service and feeder x $131.50
❑ New, or alteration to, service of 1.000 amps or greater
❑ Medical/Educational/Institutional Facility
Plan review for modified submittals $120.50/hour
MISCELLANEOUS
SERVICE/EQUIPMENT
LOW VOLTAGE
TEMPORARY SERVICE
Fire Alarm System
1s' Service/Feeder Additional Feeders
❑ Security Alarm System
❑ Voice/Data Cabling
0 - 60 amp x $ 71.00 x $ 32.00
❑ Other
61 - 100 amp x $ 80.00 x $ 39.00
Area to be served by system:
101 - 200 amp x $103.50 x $ 51.00
1st 2,500 ft2-$71.00; each additional 2,500 ft2- $18.50
201 - 400 amp x $120.00 x $ 60.50
# of Thermostats
401 - 600 amp x $163.50 x $ 80.00
First $60.50; each additional $18.50
Over 600 amp x $183.00 x $ 92.00
# of signs
"NOTE: an automation fee of $6.00 will be charged
First $60.50; each additional $28.50
on all permits"
Yard Pole/meter loops/pedestal x $ 80.00
Portable Generator (transfer equipment) x $100.50
For fixtures or fees not listed contact the Permit Center at
Ditch cover/inspection only x $120.50
253-835-2607
Bulletin #100 - 4/21/2009 Page 3 of 4 k:\Handouts\Permit Application