07-103430CITY OF
RECEI ED
Federal way
PERMIT
COMMUNITYDBVELOPMENTSERVICES
33325 AVENUE SOUTH • 63 BOX 9718
FEDERAL WAY, WA 98063-9718 ,
1UN 2 5 20
Y C A�PLICATION
253-835-2607- FAX 253.835-2609
www.cituaffederahoml.mm
QUI�pIAjG DEPT q
(253) b38
- 119 Z
The following is required information - an incomplete application will n
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SF MF CO ME EL PL DE EN /FP
be accepted. Please
SITE ADDRESS L% %✓C J� I.v r S . SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # _ - LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page/or lengthy legal description]
■ PROJECT INFORMATION
or
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
L/�/S/�/ ! /vFit�/ Add/eSSAl�I2 FI/Lt_ CO •�/ i KD! IVIIJIL h TLt I�tJ Jl Au c i o A.jci V 1 � u A L
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PROJECT NAME (Name of Business or Owner Last Name) L)11j,!�.l Ns
PEOPLE•- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE
0 ( )
MAILING ADDRESS , STATE, ZIP
COMPANY NAME
APPLICANT NAME
APPLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
M1er,�; a4 5&-o p,-
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Scor /• At ,,e, S
(253) b38
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MAILING ADDRESS
PRIMARY PHONE
� i t' - / 7't
Crff, STATE, ZIP
CELL PHONE
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pig
Kai w A. 76O'YZ
( )
CITY OF FEDERAL WAY BUSINESS LICENSE
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NUMBER EXPIRATION DATE
" /
FAX NUMBER
- _
--)�015� -
(2�3 163Q�
- op/'
CONT 'ISTRA
copy of card required with each ■ppllcatioul
EXPI
DATE
6 s c
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COMPANY NAME
APPLICANT NAME
OFFICE PHOWE-
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
( )
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
NAME
/�'Wa-
PRIMARY PHONE
� i t' - / 7't
E-MAIL ADDRESS
EXISTING ASSESSED/APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 11 PRIVATE (SEPTIC)
0
•
AREA DESCRIPTION
EXISTING PROPOSED
SQ. FT. SQ. FT.
TOTAL
SO. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
LXISTIN0
PROP096D
TOTAL
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS for Tub/Shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS (Bathroom sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS )cummuetaq
RANGES
GAS WATER HEATERS
WATER CLOSETS (rodeq _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 lincluding 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. C
NAME/TITLE
(Signature)
RELATIONSHIP TO PROJECT Q Owner ❑ Agent
❑ Contractor ❑ Architect ❑ Other
I nn - T---, t ')AAA Paor A1`4 k\Hanrinuts\Permit Annlication
•
"'' ELECTRICAL. PERMIT INFORMATION7.
RESIDENTIAL
COMMERCIAL
NEW RESIDENTIAL SERVICE
NEW COMMERCIAL/ INDUSTRIAL SERVICE
❑ Single Family Square Feet
Service or Feeder Each Add'n
(First 1300 ft2- $107.50; Each add'n 500 ft2 - $34.50)
❑ 0 to 100 amp $117.00 $ 71.50
❑ Detached outbuilding or garage
❑ 101.- 200 amp 145.00 91.50
(Inspected with service) $45.50
❑ 201 - 400 amp 272.00 107.50
❑ Detached outbuilding or garage
❑ 401 - 600 amp 317.00 127.00
(Inspected separately) $71.50
❑ 601 - 800 amp 410.00 173.50
❑ 801 - 1000 amp 500.50 209.50
NEW MULTI -FAMILY (three units or more)
❑ Over 1000 amp 546.00 291.00
Service Feeder
❑ Up to 200 amp $117.00 $ 34.50
❑ Over 600 volts surcharge $91.50
❑ 201 - 400 amp 145.00 71.50
❑ Mast or meter repair $99.00
❑ 401 - 600 amp 198.50 99.00
EJ 601 - 800 amp 254.00 136.00
ALTERED COMMERCIAL /INDUSTRIAL
❑ Over 800 amp 364.00 272.00
Service or Feeders
❑ 0 to 200 amp $117.00
ALTERED SINGLE/MULTI FAMILY
❑ 201 - 600 amp 272.00
Service or Feeder
❑ 601 - 1000 amp 410.00
❑over 1000 amp 456.50
CJ to 200 amp $ 89.50
❑ 201 - 600 amp 145.00
❑ # of circuits to be added/altered
❑ over 600 amp 218.50
(1-5 circuits - $91.50; Add'n circuits, $7.00/ea)
❑ # of circuits to be added/altered
COMMERCIAL /INDUSTRIAL PLAN REVIEW
(1-4 circuits -$71.50; Add'n circuits $7.00/ea)
$91.50 plus 35% of Permit Fee
❑ Service - 1,000 amps or greater
❑ Mast or meter repair $53.50
❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $71.50
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK
Residentia l/Multi-Family $63.00
❑ # of service or feeders
(First service/feeder-$71.50; each add'n -$46.50)
CommerciaWndustrial Service or Feeder Ampacity
❑ 0 - 100 amps $ 71.50
❑ 101 - 200 amps 91.50
❑ 201 - 400 amps 107.50
❑ 401 - 600 amps 145.00
❑ over 600 amps 157.00
U
MISCELLANEOUS SERVICE/ EQUIPMENT
❑ # of Thermostats
❑ # of Signs
(First -$53.50; add'tn-$16.50/ea)
(First sign -$53.50; add'n sign $25.00/ea)
Low Voltage
❑ Swimming pool/hot tub ................ $107.50
Square Feet to be served by system(s) 51' L (
(includes additional circuit, if required)
Fire Alarm System
❑ Yard Pole meter loops ..................... $71.50
❑ Security Alarm System
❑ Additional Plan Review $107.50/hour
❑ Voice Cabling
(for modified submittals)
❑ Data Cabling
❑ Automation Fee on all Permits $5.00
(Per Systeni(s) 1•t 2500 ft2-$63.00;
Each add'n 2500 ft2-16.50) "Per WAC 296-96.910(5)(b)6 & ii)
Rnllrtin lil011 - Tannary 1 MMA
D.na i of A