09-102453 1 •
CITY OF��,MjNll ,.EEV q - 1 V
Federal Way PERMIT — —
COMMUMTYDEVELOPMENT SERVR!ffiN 2 9 731SF MF CO ME EL PL DE EN®
33325 51"AVENUE SOUTH•PO BOX 9718
FEDERAL WAY,WA 98063-9718 k�I,I CATI O N m253-835-2607•, a5,�� FEDE�
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The ollowin! is re•uire• ,i5nation-an incom•tete a'•lication will not be acce•ted. Please •rint le!ibl (in ink)or _ .
/r •''PROPERTY INFORMATION
SITE ADDRESS 3�1��O 3 wC�./�/Ec RA"6-(d s&-YL t i I S_ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ _ _ _ LOT SIZE(sfi
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
0 DEMOLITION 0 ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
isloDl FIc/rnor/ o F &i crw4 Fite- 4z4c4-yr SYS-7-61.i i,,c__ /4Dil)ur-y
/N w iprOz 'i s &p ave 4ach- ArT /0/Ma va=t X r-
PROJECT NAME(Name of Business or Owner Last Name)()k/1f 2#71-C'-CiS ell /4 -/i7//'yt°2I4 5 uc /26 U l0
• PEOPLE INFORMATION
PROPERTY NAME � J' PRIMARY PHONE
✓�f
OWNER ( O /IA L4 5VC. (7)6 ) :Do - 3)19
MAILING ADDRESS CITY,STATE,ZIP
3'L4 I wclewthr(uslxx- w/,4-/ S. Fetieraz- wA.'/, w/f 9S'0 0 3
CONTRACTOR CAVIPANY NAME AILICANT NAME< OFFFrE PHONE
,v liefi � m-
c6L Ja ✓ Oil ici 5,4.1.L (it077; -a7)--10MAILING AD CITY.STATE.ZIP CELL PHONE
���� y�� S�CI� S. ZivrtiN, wPl- CI gC C-1 (Z: )Z5 -3 9J
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE F UMBER
•
6 -_v 6--1 ) 9 3 8- B i i. / �3/ 9 c s)a t c�9
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
d- U 1 ti '► L 9 9 5 n/ 2' V- /awl /v70/0
APPLICANT COMPANY NAME APPLICANT1,CANAME
� OFF E PHONE
CV/Vile i H- -r ci -Jog"),3 Ow L.�'es,ji' (i))a7 2 -a S�
MAILING ADDS STATE.ZIP CELL PHONE
t Z-) sfievv ll Avr S . re) 96v 5 7 (zoo) z5 c -3ki,�-
RELATIONSHIP TO PROJECT ,/ n - FAX NUMBER
❑ Architect 0 Tenant 0 Agent (Other(Describe) VF/ /O it (�r2 --),,2 -7 -u9Sic
CONTACT NAM PRIMARY PHONE E-MAIL ADDRESS
SC) Cul CA&/14-t/C. (tad) ZaS-3 /r Joth•/.Ov1u SA-14(0_coA..4,0 tnir-
Co
LENDER Per$CW 19,27,095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
,f
• DETAILED BUILDING INFORMATION
EXISTING USE /'-f 2 ,4-t�')/t I PROPOSED USE %<i?e_ a.ii i'i /,,1/4,7-7A,„,,,
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1/Odd-- V v
SPRINKLERED BUILDING? 0,YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ?ONO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE D CARPORT❑
EXISTING PROPOSED TOTAL TOTALEXISTING Sl TOTAL PROPOS®S} TOTAL Sl
NUMBER OF FLOORS
"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(Commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS 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 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 • 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 rel • e ahe cit I •• • 'ts officers a em• •yees,upon the accuracy of the information supplied to the city as a part of
this application. IF (�
NAME/TITLE �, • / DATE 7:71-9-d 9
(Signature (Title)
RELATIONSHIP 0 PROJECT ❑ Owner o Agent Contractor 0 Architect ❑ Other
FOR OFFICE USE ONLY
a NEW ❑ADDITION o ALTERATION o REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? o YES o NO
PLATTED LOT? a YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
1 • •
I
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or garage ❑ 101 -200 amp 141.00 89.00
(Inspected with service) $44.00 ❑ 201 -400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401 -600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601 -800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
❑ 401 600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ Oto 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/ea)
❑ #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 Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
❑ Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401 -600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
(First-$52.00; add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
❑ Low Voltage U Swimming pool/hot tub $87.00
Suare Feet to be served by system(s)2 CIU (Includes additional circuit,if required)
Fire Alarm System
CI Yard Pole meter loops $104.50
Security Alarm System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00
(Per System(s) 15t 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00)•Per WAC 296-46-910(5)(bl((&II)
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application