05-102265 City of Federal Way Electrical Permit #: 05 - 102265 - 00 - EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Y
Project Name: VANSICKEL
Project Address: 419 SW 304TH sr Parcel Number: 178890 0040
Project Description: Replace 125-amp panel.
Owner Applicant Contractor
MARY VANSICKEL ELECTRO SERVE LLC ELECTRO SERVE LLC
419 SW 304TH ST 13547 SE 27TH PL SUITE 3-D 13547 SE 27TH PL SUITE 3-D
FEDERAL WAY WA 98023 BELLEVUE WA 98005 BELLEVUE WA 98005
(425)451-3358
Electrical Fixtures
Description - ,Quantity Description Quantity Description Quantity
Alt.Serv./Feeder:0 to 200 amps-Res] I
PERMIT EXPIRES November 9,2005.
Permit issued on May 13,2005
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: See Application Date: S '( 3—p j
F
INALEO
THIS CARD IS TO REMAIN ON-SITE __
CITY OF A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-102265-00-EL
Owner: MARY VANSICKEL
Address: 419 SW 304TH ST
FEDERAL WAY, WA 98023-3941
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Slab/Concrete Floor(4255) 0 Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved Approved
By Date By Date 5 Dates-------051-0S------
,
❑ Under-slab groundwork(4295)
Approved
By Date
to
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I10 PERMIT SF MF CO ME 'L DE EN FP
• COMMUNITY DEVELOPMEN IO CES �•
33325 8 AVENUE SOUTH•63 BOX 97]8 00 APPLICATION TD
FEDERAL WAY,WA 98063-97]8
253-835-2607.FAX 253-835-2609
unnw_rit,ofederalwau com
The ollowin• is re•uired i ormation-an inco •lete a• •lication will not be acc••ted. Please •rint -•ibl in ink or •.j• •.
• PROPERTY INFORMATION
57� q�
SITE ADDRESS )�Ult 9t /Q "W15( SUITE/UNIT 4
ASSESSOR'S TAX/PARCEL # ( V Q Cl d - 0 i( 0 LOT SIZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
-----------
--------------
❑ DEMOLITION PiZrELECTRICAL 0 ENGINEERING-0-FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed des tion o work included on this permit only)
425
PROJECT NAME(Name of Business or Owner Last Name) '/&-S i c kek
• PEOPLE INFORMATION
PROPERTY NAME , PRIMARY PHONE
OWNER ,•lCV/ Y A/1SICJrI42-( (0,4.A.4-6-444- y/Oc) (aS3 ) Qcc - ow(
MAILING ADDRESS I' CITY,STATE, IP
4(1s� 3b4 s iL 2cJjLia /go?5
CONTRACTOR COMPANY NAME APPLICANT NAM OFFICE PHONE
C ke- rO SZirVIZ- M I vq An- (4251 653 -c,ECeeD
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE G_c!- �40..(I'25t 5E, W `� b� /a5� (2iv,&/SLIC °J OS (44t1 fS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBS Z ec
1- �-5i-_I 0 54 $(o - B L IV / ( / cS (gtec) - cit( Tr,
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Z L C- I � (.= Q. g. a )1 a 7- / o /a(0
APPLICANT COMPANY NAME . APPLICANT NAME OFFICE PHONE
/11 /Aviv, 4---1 ai C o serwL. (ccs, ) 6s 3.-�1v8'?
MAILING ADDRESS CITY STA E,ZIP „..._ CELL PHONE
13500 56 367- .11- (t Stet OS- vccP,t I\ l?&oo (ci z4 ) 96q - S t c,�(
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent Other(Describe) 6,4,U (t ) s q_ - Lq C.(e
CONTACT NAME ' PRIMARY PHONE E-MAIL� =mac, DR
Aid IYw^.- (taSi (a53 - 'tota tninkT v /1bTistAcCtcP---
LENDER isSl '19.,"f.$9$* j tdtYi/1JO7Yll4tionil I NAME
.*14.i.Q� 1I700 vatiis iiioceeds$d,Uoo''..
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO -
WATER SERVICE PROVIDER n LAKEHAVEN n HIGHLINE n TACOMA n PRIVATE!WELL)
r .-.
PROJECT FLOOR AREAS
J
- AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ.FT.
BASEMENT
- FIRST
SECOND
THIRD 2
z
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED �,// TOTAL EATING SP TOTAL PROPOSED SF
—
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS--- ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or reloca d as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ ,
AIR HANDLING UNITS EVAPORATIVE COOLERS • GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commer i IJ WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS '" GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or /Shower Combo) SHOWERS WATER-CLOSETS(roue) MISC(Describe)
DISHWASHERSINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
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 authorised 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
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.
NAME/TITLE %/&��IP.-........ .,-............_ ' // ' L.. . DATE 5/I 16.5e-
'Signature)
/O�
'Signature) / (Title) 1
RELATIONSHIP TO PROJECT 0 Owner 0 Agent Contractor ❑ Architect 0 Other
o NEW,,. a ADDITION_ - u ALTERATION 'REPAIR;- o TENANT IMPROVEMENT. ;_ '.
BUILDING SHELL ONLY?- ❑YES-o NO , ' , 'BASIC PLAN?„`= - ,, „ , ,'o'YES' ' a NO , ' '
ZONING DESIGNATION ; ' ' CHANGE Oh'USE?: - , . ; o YES o NO :,
NEW ADDRESS REQUIRED? ' a YES ❑NO 'UP/SEPA/SU?_ ti YES . ,'q NO.„
PLATTED LOT? a YES oNO ' DEMO PERMIT REQUIRED? a YES a NO'
05/12/2005 12:43 FAX 2536614048 City of Federal Way Z002/002
ELECTRICAL PERMIT INFORMATION
•
. RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
U Single Family Square Feet Service or Feeder Each Add'n
(First 1300 112-$107,50;Each rtdd'n 500 ft2-$33.50) ❑ 0 to 100 amp $1 13.50 $69.50
❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 U 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601 -BOO amp 398.50 168.50
O 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
U Up to 200 amp $113.50 $33.50 U Over 600 volts surcharge 589,00
$96.00e
0-Mast or meter repair
❑ 201 -400 atop 141.00 69.50 -
❑ 401 -500 amp 193.00 96.00
ALTERED COMMERCIAL/INDUSTRIAL
6
0 601 -800 amp 217.00 132.00
❑ Over 800;trop 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 20] -600 amp 264.50
elDService or Feeder ❑ 601 - 1000 amp 398.50
U over 1000 amp 443.50
to 200 amp $87.00
201 600 amp 141.00 ❑ # of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ca)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$69,50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Pee
❑ Service• 1,000 amps or greater
❑ Mast or meter repair $52,00 ❑ Medical/Educational/institutional Facility
MOBILE HOMES
U Service or feeder only $69.50
❑ Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residentia
1/defulti-Family $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each ad{J n-$45.00) Conunercial/Industrial Service or Feeder Ampacity
A 0-100 amps $69.50
v A C.S GZ.. re_pla ti ❑ 101-200 amps 89.00
l
❑ 201-400 amps 104.50
4JOtAll...d taV
/ / ` /,kjn ❑ 401-600 amps 141.00
1 /W�/ �'""' ❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
d #of Thermostats ❑ #of Signs
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
❑ Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit.if required)
❑ Fire Alarm System ❑ Yard Pole mctcr loops $104.50
❑ Sc unty Alarm System Q Additional Plan Review $104.50/hour
O Voice Cabling (for modified submittals)
D Data Cabling
❑ ❑ Automation Fcc on all Permits 55.00
(Per System(s) 1g 2500 112-$6 1.00;
Each add'n 2500 ft=-16.00) •per WAC_2c6.16-9Jq/SJpiyi h if)
Bulletin 11100-January 7,200S Page 3 of 4 k\tlandouts\Permit Application •