02-100288 _Citybf Federal Way Electrical Permit #:02 - 100288 - 00 - EL
Community Development Services
33530 1st WSy S
Federal Way,WA 98003-6210
Ph:253 661 4000 Fax:253 661 4129 Inspection request line: 253.835.3050
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Project Name: DIGESTIVE HEALTH SPECIALIST
Project Address: 34503 9TH S Parcel Number: 750451 0050
Project Description: ELE-Install 4 receptacles(3 circuits)in remodel area-staff lounge
Owner Applicant Contractor
ST FRANCIS MEDICAL CTR ASSOC.*ST FR SINDER ELECTRIC INC SINDER ELECTRIC INC
1717 SJ ST 15022 35TH AVE W 15022 35TH AVE W
TACOMA WA 98405-4933 LYNNWOOD WA 98037 LYNNWOOD WA 98037
(425)743-9704
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits- Commercial 3
PERMIT EXPIRES July 21,2002,IF NO WORK IS STARTED.
Permit issued on January 22,2002
I hereby certify that the above information is correct and that the construction on the above described property and
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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: (.9.aDate: /—,2•4,),-000Z
I Z 2. - D 2 Ce, ( 1.- ( 1 ` 1%0 A G T .S 0 tc `-I-7 g- 7--0 !l e j`" — i )
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CONSTRUCTION PERT APPLICATION
- -. F� APPLICATION NUMBER: az / o i te_ - &I-,
APPLICATION NUMBER: - -
JAN 2 2 ',i c APPLICATION NUMBER: = = -
**The following is required information—Please print(in ink)or type**
,- ...,.......,-,IAL..I rvIAY
Please note: ElectiiciMeri,gegbn Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: ,S1.4.50. i AVE", J ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- " , - ■ PROJECT INFORMATION
•TYPE OF PROJECT(This application): 0 BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION
^ELECTRICAL 0 Q ' ...1
ENGINEERING❑/FIRE PREVENTION SYSTEM c
PROJECT DESCRIPTION(Provide detailed description): I, -- j AEC. (..i G/,cwr.J
i/o a mem. —Ii 1 AIL _ V A
PROJECT NAME: l IeM-i. VG 11-64411
■ PEOPLE INFORMATION
PROPERTY OWNER: E: P4/WRC
Mp.� (y/�(/ /��1(/. /Y'I'�/,�p^ DAYTIME PHONE:
, 514NG ADDRESS(ADDRESS ,STATE,ZIP): l )
fl17 Sr, J 5 T, r Ok ?Vac
CONTRACTOR: NAME: DAYTIME PHONE:
5/A)DEk E W2S1 773 -97of
MAILING ADDRESS(STREET DRESS;CITY,STA IP): ��//���� EEVENING PHONE:
/So-2X 3S WE, . LYN,t/ if), i4,4 �TJ037 NUMBER:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
11 - I 1 L o (o 1 ? L—C° (9X)7 c - 8'
CONTRACTORS REGISTRATION
NUMBER: EXPIRATION DATE:
39Y omrd required) £O- S/LO _ 13? nq-
- - L. / 's / 3
APPLICANT: NAME: DAYTIME PHONE:
AL�LJRESS n� (XVD) 7 -SSM
t' MAILING (STREET RESS;CITY,STATE,ZIP): EVENING PHONE:
Awo /06 Pl., rA), Eiyircri s,c. . IMO ( ) -
1 RELATIONSHIP TO PROJECT: FAX FAX NUMBER:
/S
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): EM ( ) -
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: a LAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL) 1
SEWER SERVICE PROVIDER: 0 LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PRO3ECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND 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 ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) 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 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 city,induding its officers and employees,upon the accuracy
of the information supplied to the city as a TITpart of this application. �
NAME/ LE: "/ / ^
DATE: 6 U�
❑ PROPERTY OW rl R &PPLICANT ❑ CONTRACTOR
FOR OFFICE USE ONLY:-
❑
'NEW Ti ❑ADDITION CI ALTERATION :❑ REPAIR - ❑ TENANT IMPROVEMENT
CENSUS CODE: - -LOT SIZE: ,
.ZONING DESIGNATION:- BUILDING SHELL ONLY? :❑ YES ❑ NO
COMPPLAN DESIGNATION BASIC PLANT.' . ❑ YES - ❑ NO
;SECTION; ; > -TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑NO
• PLATTED LOT? ❑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
• 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-S 11.00ca)
(First 1300 ft2-$72.00;Each add'n 500 ft2-$23.00) _Service and feeder $78.00 _#of Low voltage fire or burglar alarms
Feet: First 2500 ft2-$42.00;Each add'n 2500 ft2-$11.00
_Each outbuilding or garage $30.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _#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) _S$1mm0 each)chol,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 _0 to 200 $ 78.00
_Up to 200 amp $ 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 _201-400 182.00 72.00 3#of circuits
_Over 800 amp 243.00 182.00 _401-600 212.00 85.00 (1-5 circuits-$61.00;Add'n circuits,S5 ca)
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/Industiral
_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
_#of circuits _over 600 105.00
(1-4 circuits-$48.00;Add'n circuits$5 ea)
If service is greater than 200 amp,a plan review is req'd.Fee is 35%of permit fee+$61.00.Add'I plan review for other submissions is 572.00/hr.
'FD(TURE=DESCRIPTION'(A].:fFIXTURE1FEE FROM TABLED(B)tVA NUMBER`OF,UNITS(C) t° 1114* TOTALg(D) c
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g':'-:'..:=..-TOTAL-COLUMN(D):'_
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from rine 12
Estimated Plan Review Fee: $56.25+ 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)
SBCC Surcharge:(19) (21) (23)
TOtal(Pagesone&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)= (24)
Bulletin#100-August 20,2001
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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)$24.25
(2)$501.00 to$2,000.00 (2)$24.25 for the first$500.00 plus$3.27 for each additional$100.00 or fraction thereof,to and Indudi .$2,000.00
(3)$2,001.00 to$25,000.00 (3)$71.46 for the first$2,000.00 plus 515.00 for each additional$1,000.00or fraction thereof,to a - .uding
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$403.61 for the first$25,000.00 plus 510.82 for each additional$1,000.00 or fraction - -.f,to and including
$50,000.00.
(5)$50,001.00 to$100,000.00 (5)$664.35 for the first$50,000.00 plus$7.50 for each additional$1,000.00 or • •, . .,to and Including
$100,000.00.
(6)$100,001.00 to$500,000.00 (6)$1,025.55 for the first$100,000.00 plus$6.00 for each additional$1,000.r'. fraction thereof,to and induding
$500,000.00
(7)$500,001.00 to$1,000,000.00 (7)$3,337.23 for the fist$500,000.00 plus 55.09 fir each additional$ ..M..1 or fraction thereof,to and indudirg
$1,000,000.00.
(8)$1,000,001.00 and up (8)$5,788.23 for the first$1,000,000.00 plus .• n ,r r%• •1 1 r r h.hr or fraction thereof.
Bold number is the base fee for the specified increment
jtali zed underfined number is the fee iter additional .' increment
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PLUS: Add percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan revie ee.
Add 15 percent of the base building permit fee for Fire District#39 surcha •e,commercial only.
Add$4.50 for WA State Building Code Council,plus$2.00 per unit ford .ex&above.
**Electrical,plumbing,and m-s ., cal fees are calculated separately**
■ BUILDING
• PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a) 1..- Fee:
(b) dditional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surchar. •: (3)
(COMMERCIAL ONLY)
■ MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Nu '•-r: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: ('
Estimated Plan Revie Fee: (5)
■ FIRE PREVENTION SYSTEM
PROPOSED VALU ON:
FEE FACTO' 'OM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
■ PLUMBING
Base Fee Number of Fixtures
$21.00+{ X$7.00/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)