04-101161 Ity or Federal Way Electrical Permit #:04 - 101161 - 00 - EL
•munity Development Services
335 4 1st Way S
Federal Way,WA 98003-6210
Ph:253 661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: MEDANI MEDICAL OFFICE
Project Address: 34716 1ST a-COG 5 Parcel Number: 202104 9013
Project Description: Altering(5)circuits for new switches,recepticles,and existing light relocation
Owner Applicant Contractor
DR.MEDANI INTERSTATE ELECTRIC INTERSTATE ELECTRIC
34716 1ST AVE S INTERSTATE ELECTRIC INTERSTATE ELECTRIC
FEDERAL WAY WA 98003 4062 JACKSON HWY 4062 JACKSON HWY
CHEHALIS WA 98532 (360)262-0771
Electrical Fixtures
__ Description 1Quantity Description Quantity Description Quantity
Circuits- Commercial 5
PERMIT EXPIRES September 26,2004.
Permit issued on March 30,2004
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.
Owner or agent: --� c-- Date: 3 -30- 0 Li-
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fsr) 4 0,A;,,,, Cbk>ge..,
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Ct �DEM� SERVICES
3 WAY SOUTH•PO BOX 9718
of�� FEDERAL WAY,WA 98063-9718
eraI Way PERMIT APPLICATION MAR 3 0 203-6'w';5.F �U066n1-129
For Office Use only:
FW File Number:
Q 1111= - r 07-Y0 JEDERAL
The oilowin• is re•aired in ormation-an into •lete a••lication will not be acce•ted. Please •rint le•ibI (in ink)or • .
/ ^ ■ PROPERTY INFORMATION
SITE ADDRESS: 3(4'7 1 `.F' A V E 5 SaggiogiztSUITE/APT# •I
ASSESSOR'S TAX/PARCEL#: - SQUARE FOOTAGE OF LOT:
LEGAL DESCRIPTION(e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
*ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only): \1^ç--c , l 5µr t 1-C(^e$
Qr.- R2c95 • 4- R-eIoG.+4-e_ -0-x.SI-% nS L !G\i S
PROJECT NAME(Name of Business/Owner Last Name):
• PEOPLE INFORMATION
PROPERTY NAME: PRIMARY PHONE:
OWNER 0R• e 'okIn1 ( ) -
MAILING ADDRESS(STREET ADDR SS;): CITY,STATE,ZIP
3 4 `7 1 G 1-S 4 t .o .r-‹. -e1 kJ y_cy ANA- °t g-0 03
CONTRACTOR NAME COMPANY OFFICE PHONE:
.. .NVe_cs1-k-1' - 2l ec{-,--,c_ (3to ) zGz - o? -71
MAILING ADDRESS STREET ADDRESS;(: •CITY,STATE,ZIP CELL PHONE:
14(3 7'.•-ADDRESS
> 14.+.)y Chelblts /4u4 RgS-z ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER:
- - - / / ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
'
(coPy of card required with each application(
N-1--e r e - 0 2 3 fill /
LENDER NAME: DAYTIME PHONE:
(If Proposed Value>$5,000) ( ) -
MAILING ADDRESS(STREET ADDRESS;(: CITY,STATE,ZIP
I
I
APPLICANT: NAME: COMPANY OFFICE PHONE:
( ) -
MAILING ADDRESS(STREET ADDRESS(: CITY,STATE,ZIP EVENING PHONE:
( ) • -
RELATIONSHIP TO PROJECT: FAX NUMBER.
0 Architect 0 Tenant 0 Other(Describe). ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner 0 Contractor 0 Applicant E-MAIL ADDRESS:
■ DETAILED BUILDING INFORMATION
EXISTING USE: •
* PROPOSED USE: •
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? o YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
I
■ PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL I
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY'* NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• FIXTURES
Indicate number of each type of fixture that is 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(Commercial) WOODSTOVES i
BOILERS FIREPLACE INSERTS RANGES MISC(Describe) +,
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toile) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAYS(e,th.00m Sall VACUUM BREAKERS ELECTRIC WATER HEATERS
iI
■ 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 i
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, i
including its officersceand employees,upon the accuracy of the information supplied to the city as a part of this application.
NAME/TITLE: u'�- c ''O'eS_ DATE: 3 r 3 d -d L ,
(Signature) (Title) I
RELATIONSHIP TO PROJECT: 0 Property Owner ❑ Applicant 0 Contractor 0 Architect 0
-ex
,FOR OFFICE,USEONLY: •,„...,:"
o NEW a ADDITION o ALTERATION ❑REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? a YES ❑NO
• ;ZONINGDESIGNATION:- - _ - CHANGE OF USE? • o YES o NO
NEW ADDRESS REQUIRED? o YES a NO IIP/SETA/SII? o YES a NO
PLATTED LOT? ❑YES ❑NO DEMO PERMIT REQUIRED? o YES ❑NO
I lu ia•u n 7:0'.; ,:a. . ,, „ i Page 2
■ ELECTRICAL PERMIT INFORMATION
i
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
CISingle 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 ❑ 201-400 amp 220.50 87.00
❑ Detached outbuilding or garage ❑ 401-600 amp 256.50 103.00
(Inspected separately) $58.00 ❑ 601 -800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) Li 801 - 1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
Li 201 400 amp 117.50 58.00 Li Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 0 Mast or meter repair $80.00
❑ 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY ❑ 0 to 200 amp $ 94.50
(Inspected separately from service) ❑ 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 ❑ 13#of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
LI Service over 200 amps
❑ Mast or meter repair $43.50 ❑ Medical/Educational/Institutional Facility
$74.00 plus 35%of Permit Fee
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES TEMPORARY SERVICE
U Service or feeder only $58.00
❑ Service and feeder $94.50 Commercial Residential
❑ 0- 100 $58.00 $51.00
MOBILE HOME/RV PARK ❑ 101 -200 74.00 51.00
❑ #of service or feeders ❑ 201 -400 87.00 n/a
(First service/feeder-$58.00;each add'n-$37.50)
❑ 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats LI #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
LI Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s): (Includes additional circuit,if required)
❑ Fire Alarm System LI Yard Pole meter loops $58.00
❑ Security Alarm System ❑ Additional Plan Review
❑ Voice Cabling (for modified submittals) $87.00/hour
❑ Data Cabling
O .
(Per System(s): 1•t 2500 ft2-$51.00;
•
Each add'n 2500 ft2-13.50)•Per WAC 296-46-910(5)(b)#&u)
•
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