02-100410 rof
C mmunity Development Services Federal Way
Community Electrical Permit #:02 - 100410 - 00 - EL
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: SAFEWAY SELECT BANK
Project Address: 1207 S 320TH Parcel Number: 150050 0020
Project Description: ELE-Install 50 amp circuit to prewired unit at instore bank.
Owner Applicant Contractor
1560 INVESTORS LLC TANDEM ELECTRIC INC TANDEM ELECTRIC INC
200 S BROAD ST#6 5836 S 228TH ST 5836 S 228TH ST
KENT,WA KENT,WA
98032 (253)395-8806
Electrical Fixtures
Description Quantity Description IQuantityl Description Quantity
Service/Feeder: 0-100 amps-Comm. 1
PERMIT EXPIRES July 28,2002,IF NO WORK IS STARTED.
Permit issued on January 29,2002
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Wa .
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Owner or agent: (i(�tp�a Date:
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o, GCONSTRUCTION PERMIT APPLICATION
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APPLICATION NUMBER: -
APPLICATION NUMBER: -
**The following is required information—Please print(in Ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permit may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS:a/ r7 S• 3 a 0 *- ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING o MECHANICAL ❑ DEMOLITION
'ELECTRICAL o ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION/(Provide detailed description):
W r r\S I i ( - c
C \r pr-e ,-`-,
PROJECT NAME: � wL� Laikk.
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: C AD( fp DAYTIME(AS
MAILING ADDRESS(STREEADDRESS;CITY,STATE,94):
g20 S. 3,?d'
CONTRACTOR: NAME �//� �,� DAYTIME PHONE:
C� (�'CVS3)3�fS - �6
h .• 1 ET ADDRESS;QTY,STATE,ZIP): EVENING PHONE:
QTY OF FEDERAL WAY BUSINESS LICENSE NUMBERI� — L V / 2 - do '3�FAX ) ) c.
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(CONTRACTORS�u'REGISTRATION NUMBER: (f— h I coL — -3 / c / O
copy of card
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ARCHITECT o TENANT o OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑PROPERTY OWNER ❑APPLICANT •. CONTRACTOR
• DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINICLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: o YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAIEHAVEN o HIGHLINE o TACOMA ❑ PRIVATE(WELL)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
r ,
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHERS) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
• DISCLAIMER/SIGNATURE BLOCK
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 a - out the reliance of the city,including its officers and employees,upon the accuracy
of the information suppl the - a • rt . Is application.
NAME/TITLE: ./ A P66 DATE: /,-,""\-e()
I
o PROPERTY OWNER ❑APPLICANTNTRACTOR
FOR OFFICE USE ONLY:
a NEW ❑ADDITION ❑ALTERATION ❑REPAIR o TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION: BUILDING SHELL ONLY? o YES o NO
COMP PLAN DESIGNATION BASIC PLAN? a YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑YES ❑ NO
PLATTED LOT? o YES o NO CHANGE OF USE? ❑YES ❑ NO
■ ELECTRICAL
TABLE B
• NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $48.00 _#of Thermostats(First-$36.00;add'n-S11.00ea)
(First 1300 If-$72.00;Each add'n 500 ft-$23.00) _Service and feeder $78.00 _ll of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$42.00;Each add'n 2500 ft-$11.00
_Each outbuilding or garage $30.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _H of service or feeders 'Per WAC 296-46-910(5)(b)(i&ii))
_Each outbuilding or garage $48.00 (First service/feeder-$48.00;Add'n service/ _#of Signs(First sign-$36.00;add'n sign
(Inspected separately) feeder-$31 each) $17.00 each)
_Swimming pool,hot tub,spa 72.00
_Yard Pole meter loops 48.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n L 0 to 200 S 78.00
' _Up to 200 amp S 78.00 $ 23.00 Feeder _201-600 182.00
_201-400 amp 97.00 48.00 _0 to 100 $ 78.00 $ 48.00 _601-1000 274.00
_401-600 amp 133.00 66.00 _101-200 97.00 61.00 _over 1000 305.00
_601-800 amp 170.00 91.00 _ (1
201-400 182.00 72.00 _H of circuits
_Over 800 amp 243.00 182.00 _401-600 212.00 85.00 -5 circuits-$61.00;Add=n circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 274.00 116.00
• (When inspected separately from the services.) _801-1000 335.00 140.00 TEMPORARY SERVICE
Service or Feeder _Over 1000 365.00 195.00 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp $66.00 _Over 600 volts surcharge 61.00 _0-100 48.00
_201-600 amp 97.00 _Mast or meter repair 66.00 _101-200 61.00
_over 600 amp 146.00 201-400 72.00
_Mast or meter repair 36.00 401-600 97.00
_M of circuits _over 600 105.00
(1.4 circuits-$48.00;Add'n circuits S5 ea)
If service is greater than 200 amp,a plan review is req'd.Fee is 35%of permit fee+$61.00.Add=1 plan review for other submissions is$72.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) , TOTAL(D)
TOTAL COLUMN(D):
Total Col (D)
-�/
Estimated Permit Fee: (12) L 4 Q
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $61.00+( X.35)=(13)
• DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
• ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
■ OTHER FEES
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Mitigation Fee:(18) (20) (22) •
SBCC Surcharge:(19) (21) (23)
Total (Pages One&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)= (24)