02-100337 City of Federal Way
Community Development Services Electrical Permit #:02 - 100337 - 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: DIGESTIVE HEALTH ENDOSCOPY
•
Project Address: 34503 9TH S Parcel Number: 750451 0050
Project Description: ELE-Lay down voice/data cabling
Owner Applicant Contractor
ST FRANCIS MEDICAL CTR ASSOC.*ST FR BLACK BOX NETWORK SERVICES BLACK BOX NETWORK SERVICES
1717 S J ST BLACK BOX NETWORK SERVICES BLACK BOX NETWORK SERVICES
TACOMA WA 98405-4933 200 ANDOVER PKWY E 200 ANDOVER PKWY E
TUKWILA WA 98188 (206)575-1363
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Low Voltage-Other Commercial
PERMIT EXPIRES July 23,2002,IF NO WORK IS STARTED.
Permit issued on January 24,2002
• 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 Way.
Owner or agent: _ Date: ) � y
ZS �--p Cer I o% CPvt(L- PID g- DK , — E�
z- os- - 07— rim-4(
• •
( ,...
arroyof G CONSTRUCTION PERMIT APPLICATION
uV L' APPLICATION NUMBER: 0 2.- L 0 0 3 3 7- at
APPLICATION NUMBER: - - ,
•
APPLICATION NUMBER: - -
• **The following is required information-Please print(in ink)or type** .
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
' - . - • - - - • PROPERTY INFORMATION
SITE ADDRESS: ;1715-0,.5 7°h,4l/6--. ASSESSOR'S TAX/PARCEL #: 1 S O (4 s .1 - trO$ 7
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
-, . , .. . ;:; , -=- , ■. PROTECT INFORMATION ' . . - - - - •
TYPE OF PROJECT(This application): BUILDING CI PLUMBING CI MECHANICAL ❑ DEMOLITION
E ECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): 1/ 11 /Sir - .pfaCI1,L? 6--
PROJECT NAME: RIM D}/S (s6G//N&
• PEOPLE INFORMATION
PROPERTY OWNER: NAMEDAYTIME PHONE:
Ls 6<S-7/VC- 64t7N .'.'vb,os czy' ( )
MAILING ADDRESS(STREET AD RE CITY,STATE,ZIP):
39503 6/" 5, ,e L44-7, w,4 5QUO ''
CONTRACTOR: NAME
,�J DAYTIME PHONE: i
1%tifc! NGX Ilky1.✓D.GI6 ,S,c.CV/LBS (.4-) 575- -)A0'
MAILING ADDRE (STREET ADDRESS; ,STATE,ZIP): EVENING PHONE: I
CITY OF FEDERAL WAY BUSINESS U NSE NUMBER: FAX NUMBER:
- - (,2o4-)_5'7c- J3 - 7 CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) . i1`L 14- ,�J 5 y I D7-.- / /
APPLICANT: NA DAYTIME PHONE:
•
lir/,,7 / ; [1tie 6 PA / ta - ( )
MAILING ADORE)!(STREET ADD S5,CITY STATE,ZIP): ` EVENING P"`/HONE:
!
RELATIONSHIP TO/� 4A'C PROJECT: lam'(A v✓✓' nes- (
NUMBER:
❑ ARCHITECT ❑ TENANT p 'FHER(DESCRIBE): ( ) -
VV 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: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: Cl LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
•
■ PROSECT 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: 0 ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) 0 ELECTRIC 0 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 daim(induding costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of the information supplied to the ., as a part o this appli
NAME/ E: .i „C/L DATE:
❑ PROPER • R- ■ APPLI NT ' CONTRACTOR
=FOR OFFICE USE ONLY: 1
D:NEW=_ fl ADDITION 0 ALTERATION = ❑.REPAIR ❑TENANT•IMPROVEMENT
=CENSOS CODE: LOTSIZE: __ - • -
ZONIN_G DESIGNATION: BUILDING SHELL-ONLY? 0 YES 0 NO
COMP=KLAN DESIGNATION - _ _BASIC PLAN' ❑ YES 0 NO '
:SECTION=:__ _ TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
'P1 TTED1OT? ❑ YES ❑ NO CHANGE OF USE? ❑YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.citvoffederalway.com
Ar .. • . I
• ELECTRICAL
TABLE B
•
• NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $50.00 _I/of Thermostats(First-$37.50;add'n-$11.50ca)
(First 1300 ft2-$75.00;Each add'n 500 It'-$24.00) _Service and feeder $81.00 _L#
#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft'-$43.50,Each ydd'n 2500 ft'-511.50
_Each outbuildingor garage.... . . $31 00 MOBILE HOME/RV PARK Square Feet• ,2 So
(Inspected with service) _#of service or feeders * Per\VAC 296-46-910(5)(b)(i&ii)
_Each outbuildingor garage. . . . . ... $50.00 (First service/feeder-550.00,Add'n service/ _k o1 Signs(First sign-$37.50,add'n sign
(Inspected separately) feeder-$32 each) $17 50 each)
_Swimming pool,hot tub,spa .. .$75.00
_Yard Pole meter loops $50 00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200................................ ..$ 81.00
_Up to 200 amp $ 81.00 ....$ 24.00 Feeder _201-600. . . 189 00
_201-400 amp 101.00 ..........50.00 _0 to 100 $ 81.00.....$ 50.00 _601-1000............ . 284.50
_401-600 amp 138.00 68.50 _101 -200 101.00 63.50 _over 1000 317.00
_601-800 amp 176.50 94.50 _201 -400 189.00 75.00 _#of circuits
Over 800 amp 252.50 189.00 _401-600 220.50 88.50 (1-5 circuits-$63.50;Add'n circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800.. . . 284.50 120.50
(When inspected separately from the services.) _801-1000 348.00 145.50 TEMPORARY SERVICE
Service or Feeder _Over 1000 379.00 202.50 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp S 68.50 _Over 600 volts surcharge 63.50 _0- 100 $ 50.00
_201-600 amp 101.00 _Mast or meter repair 68.50 _101-200 63.50
_over 600 amp 151.50 _201-400 - 75.00
_Mast or meter repair 37.50 _401-600 101.00
_#of circuits over 600 .. . . ..... .. .. ..........109.00
(1-4 circuits-$50.00;Add'n circuits$5 ca)
If service is greater than 200 amp.a plan review is req'd Fee is 35%of permit fee+$63.50.Add'I plan review for other submissions is$75.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50 +( X.35) = (13)
■ DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
• ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
• OTHER FEES -
Mitigation Fee: (18) (20) (22)
4 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)
Bulletin #100-January 18, 2002
t . •
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
•
TABLE A •
TOTAL VALUATION FEE FACTOR
(1)$1.00 to$500.00 (1)$26.00
(2)$501.00 to$2,000.00 (2)$26.00 for the first$500.00 plus$3.50 for each additional S100.00 or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$78.50 for the first$2,000.00 plus$1550 for each additional$L000.00or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$435.00 for the first$25,000.00 plus$11.00 for each additional$1,000.00 or fraction thereof,to and
including$50,000.00.
(5)$50,001.00 to$100,000.00
(S)$710.00 for the first$50,000.00 plus$8.00 for each additional$1.000.00 or fraction thereof,to a
induding$100,000.00.
(6)$100,001.00 to$500,000.00
(6)$1,110.00 for the first$100,000.00 plus$6.00 for each add�tonal$1.000.00or fraction _- ,f,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$3,510.00 for the fist$500,000.00 plus$5.50 for each additional S1,000.00 Of .•i. thereof,to and
including$1,000,000.00.
(8)$1,000,001.00 and up
(8)$6,260.00 for the first$1,000,000.00 plus$4.00 for each additional$1., .r or fraction thereof.
Bold number is the base fee for the specified increment
italicized underlined number Is the fee ver additional specified in., ment
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fre District#39 surcharge,commercial only.
Add$4.50 for WA State Building Code Coundl,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are cal„ated separately**
IN BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional In. ment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
■ MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION: -
FEE FACTOR FROM TAB ' A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Perm'• ee: (6)
Estimated P an Review Fee: (7)
IN PLUMBING •
Base Fee Number of Factures
$22.50+{ X$8.00/fixture}= (8)Estimated Permit Fee ,
Estimated Permit Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)