04-101210 41111
City of Federal Way
Community Development Services Electrical Permit #:04 - 101210 - 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: EVERGREEN SALES&LEASE
Project Address: 33216 PACIFIC S Parcel Number: 797820 0010
Project Description: Electrical service conversion from overhead to underground in conjunction with Pacific Highway ROW
expansion project.
Owner Applicant Contractor
CITY OF FEDERAL WAY* 4ARWAN SALL( POTELCO INC POTELCO INC
33530 1ST WAY SOUTH POTELCO INC POTELCO INC
141058TH STE 141058TH STE
\FEDERAL WAY WA 98003 SUMNER WA 98390 (253)863-0484
Electrical Fixtures
Description Quantity Description IQuantity Description ,Quantity
Alt.Serv./Feed 201 amps-600 amps-I
PERMIT EXPIRES September 29,2004.
Permit issued on April 2,2004
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. See
Owner or agent: SApplication Date: ( 01 —0`f
4 _ o')'"-Ce-74'C41S
f:// It)()4'7
Federal Way PERMIT RECEIVED o 1 - I b ' -A LO..
COMMUNITY DEVELOPMENT SERVICES SF MF COM PL DE EN FP
33530 FIRST WAY SOUTH•P0 BOX 9218
53-61- WAY,
AX APPLI CATI ONO 1 2°°41-
OO °
I1; F2536-4129
www.dttp(ederrdwattrom
CITY OF FEDERAL AY
The ollowin• is re•aired in ormation-an inco .lete a.•licationBlzir a I Ei ted. Please •rint le•ibl (in or
PROPERTY INFORMATION
SITE ADDRESS 33 c)--I (pI �I c S
7 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 7 ? 0_ - O t Q LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description,
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed des tion of work included on e this permit only)
etn c e CO -<<on CX ec . c ,de r0C..f,CA _
PROJECT NAME(Name of Business or Owner Last Name)
�1/ e.e41/4-- l s
e i k.ease__
PEOPLE INFORMATION
PROPERTY NAME
PHONE
OWNER / rGx'el SQ"UC.tnn Cr..t crP r2ri=r\ (253 )6G1 -1415-2.
MAILING ADDRESS CITY,STATE,ZIP
S.o `r� C . \ ICDA GidlOG3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
C e\ser n c 0X4�,- . ccs s e ) K3 cA f'
MAILING ADDRESS �� CITY,STATE,ZIP CELL PHONE
ItAKS F a-" _ Sc l m 2r,CJA o wZrnGS -csr
CITY OF FEDERAL
-`USAN LICENSE NUMBER_ 12-
'EXPIRATION DATE (2FAX
73NUMBER
F“ -ITR
"CCCOCNTTRRACTOGR'S REGISTRAT`IOIN NUMBER(copy(copy of card required with each app2lication) EXPIRATION DATE
9C \--czLX4344 bU /e3( / Ci
APPLICANT
C/
cLIkPANY NAME APPLICANT NAME
� OFFICE PHONE
o �S'v
f \c - ( 4y
�-)( c e it (273 )Kg -CX}?
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
klAkC.) f= SC )r>QrC c? nC) (C12f7CC -G\'-3G
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ' Other(Describe) C - (2S7 1
2S3) I;63
3 -e--7
CONTACT N1M&tt�� �N PRI Es (253 PHONE -CS-4P(-1
-�!`P( 1 E-MAIL ADDRESS \ `
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
. . DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS"' TOTAL EXISTO G TOTAL.PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated 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(comm•rmaq WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or rub sho..«combo) SHOWERS WATER CLOSETS Irmt•q MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Smks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK S
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 ma•e by any person, including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance o ec•t incl •ing its fflcers and employees, upon the accuracy of the information supplied to the city as a part of
this application. ,
NAME/TITLE DATE 1//�''/c/V%(
( ignature) Owner (Tat ) rO
RELATIONSHIP TO PROJECT ❑ Owner o Agent 0 Contractor ❑ Architet�
Architect Other
FOR OFFICE USE ONLY
o NEW o ADDITION o ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES o NO UP/SEPA/SU? a YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—March 30,2004 Page 2 of 4 k\I landouts—Revised\Permit Application
•
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
LISingle Family Square Feet
Service or Feeder Each Add'n
(First 1300 ft2-$87.00, Each add'n 500 ft2- $28.00) ❑ 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage LI 101 -200 amp 117.50 74 00
(Inspected with service) $36.50 Cl 201 -400 amp 220.50 87.00
❑ Detached outbuilding or garage ❑ 401 -600 amp 256.50 103.00
(Inspected separately) $58 00 LI 601 -800 amp 332 00 140 50
NEW MULTI-FAMILY(three units or more) LI 801 - 1000 amp 405 50 169.50
Service Feeder LI Over 1000 amp 442.00 236 00
LI Up to 200 amp $ 94.50 $ 28.00
Li 201 -400 amp 117.50 58.00 LI Over 600 volts surcharge $74.00
LI 401 - 600 amp 161 00 80.00 LI Mast or meter repair $80.00
LI 601 - 800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
LI Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY 0 to 200 amp $ 94.50
201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72 50 LI over 1000 amp 369.50
❑ 201 - 600 amp 117.50
Li over 600 amp 177.00 ❑ # of circuits to be added/altered
(1-5 circuits-$74 00;Add'n circuits,$6 00/ea)
❑
it of circuits to be added/altered
(1-4 circuits-$58 00;Add'n circuits$6-00/ea) COMMERCIAL/INDUSTRLAL PLAN REVIEW
$74.00 plus 35%of Permit Fee
LI Mast or meter repair $43.50 LI Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
LI Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
❑ Service or feeder only $58.00 TEMPORARY SERVICE
❑ Service and feeder $94 50
Commercial Residential
MOBILE HOME/RV PARK ❑ 0- 100 $58.00 $51.00
❑ #of service or feeders ❑ 101 - 200 74.00 51 00
(First service/feeder-$58 00,each add'n-$37 50)
LI 201 -400 87 00 n/a
LI 401 -600 117 50 n/a
LI over 600 127 00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ # of Thermostats ❑ #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43 50, add'n sign$20.50/ea)
Cl Low Voltage LI Swimming pool/hot tub..... . ... .... $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System ❑ Yard Pole meter loops . . -- $58.00
❑ Security Alarm System LI Additional Plan Review
El Voice Cabling $87.00/hour
(for modified submittals)
0 Data Cabling
(Per System(s) 1 i 2500 ft'-$S1 00,
Each add'n 2500 ft2-13 50) •Per WAC 296-46-910(5)(b)(1&e)
Bulletin#100-March 30,2004 Page 3 of 4 k\I landouts-Revised\Permit Application