02-103566 City of Federal Way
Community Development Services Electrical Permit #:02 - 103566 - 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: MOSS
Project Address: 5122 SW 327TH Parcel Number: 189832 0170
Project Description: ELE-Altering up to 4 circuits for fire damage repair
Owner Applicant Contractor
James D Moss James D Moss James D Moss
5122 SW 327TH PL 5122 SW 327TH PL 5122 SW 327TH PL
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
1..,98023-1942 98023-1942
Electrical Fixtures
"„Quantit'jr - escription.` • m'” ' Quajrltity ` " "M,`' TDescriptlon !Quantity
Alt.Serv./Feeder:0 to 200 amps-Res. 4
PERMIT EXPIRES February 16,2003,IF NO WORK IS STARTED.
Permit issued on August 20,2002
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: Date: 00/OL
( — ? o v3 � �� Cf','ti-oma ` --
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C.T.a �v t ONSTRUC1 ION PERMIT APPLICATION
� E APPLICATION NUMBER: Q p-- L 03566_ oc a_
' 2,0 ,2�U2 APPLICATION NUMBER: _ _ - _
�j6`^-� y ��EpERA��(4P'i' APPLICATION NUMBER:
� I� �L lv COB-�Lott�Q�P,owing is required information-Please print(h1 ink)or type** ."
(:)-- ',„ C._0 Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
,f&z:§'�y,=-. .4:, -r:5,,:< .*= . .- . --tn?-,;�<:� ,i;:411 sPROPERTYINFORMATiON'?:", -: -. _ . -. --:,'-'..--f--.7-1;::-::::'-•.; .;: �-: ::
SITE ADDRESS: _ :_- 5,/.) :::;._. . "-r''t ASSESSOR'S TAX/PARCEL ii: 7 .. =
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.= : .)' - )�- 1BcI'332-ofd - - - ,—
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
f-;'--.:.il: :k_ .=" ':,: ::;:i i A_ .,-: : :1♦ VR07ECTINFORMATION. '-
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TYPE OF PROJECT(This application): [ 'i3UILDING ❑ PLUMBING L�/MEC`HANICAL ❑ DEMOLITION
L" ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):- . r ...../47 , i1—' ..)L:--�.
c__
PROJECT NAME: iCIQ:]j
;.4 ::: :: - - .. .-.. _: . <`_:li'PEOPLEINFORMATION 1----...--:',:;;:::'::'..- . . .. ., . - .. • - --1- :::.:1-:-.'-'. =
PROPERTY OWNER: NAME DAYTIME PHONE
i--1/::. /.1"1-..7
MAILING ADDRESS(STREET ADDRESS,CITY,STATE,ZIP)
_/a , 5-'2. S's) ":',2_"-.--1-' _ �-1 c-%'7..>J,:l ' it 7 PSG
CONTRACTO �11 NAME DAYTIME PHONE
95S' I),h �Il_G ( )
MAIUNG ADDRESS(STREET ADDRESS,CITY,STATE,ZIP): EVENING PHONE
CC// CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER- FAX NUMBER
— —
CONTRACTOR'S REGISTRATION NUMBER. ( )EXPIRATION DATE.
(copy of card required) / /
APPLICANT: NAME- DAYTIME PHONE:
•
MAILING ADDRESS(STREET ADDRESS,CITY,STATE,ZIP) EVENING PHONE
( )
RELATIONSHIP TO PROJECT [Y
FAX NUMBER
CI ARCHITECT C] TENANT IJ OTHER( DESCRIBE): )i)'%• '.- ( )
E-MAIL ADDRESS
CONTACT PERSON FOR THIS PROJECT: PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
-:;7",:::s = Y 'f 'il:'-:t-1.111".DETAILED BUILDING INFORMATION . :"':?;*r_°-} _ .':;'.- � -
EXISTING USE: I. '`-/J'- EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ` ))),
PROPOSED USE: OPOSED VALUATION FOR IMPROVEMENTS: $ v�� i� L/ L
SPRINKLERED BUILDING? Cl YES IXNO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES E!J NO
WATER SERVICE PROVIDER: I ) LAKEHAVEN ❑ HIGHLINE I/TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: I.LAKEHAVEN ❑ HIGHLINE H I PRIVATE(SEPTIC)
f '
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
C 33530 First Way South
�' G��`� - PO Box 9718
, .4-2jk •IMZI .E. v Federal Way WA 9.8063-9718
253-661-4000;Fax 253-661-4129
144WG www.ci.federal-way.wa.us
O PLS �
OF FV Gless�p1
r Affidavit in Lieu of General Contractor Registration
State of Washington )
County of King )
I, __)• /055 -C- • , state as follows:
(Print name as signed)
1. I have made application for a building permit from the City of Federal Way, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington(RCW),a copy of which is printed on the reverse side of this affidavit.
3. I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Federal Way must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Federal Way of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090, I
consider the work authorized under this building permit to be exempt under No. .11 , and will
therefore, not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engag- an unregistered contractor to perform construction work.
•APPLIC. T'S SIGNATURE
Sionel and sworn to before me this
-Day of 61.,20D2<
41 L-ammty
Notary's Name(Print)
µogw /-
Notary's Signature
NOTARY PUBLIC in and for the
Stat of residing at
County.
My Commission expires: #H703
Bulletin#116-April 26,2001 Page 1 of 2 k:\l-Iandouts-Revised\Contractor's Affidavit
LA,,'
**NEW RESIDENTIAL CONSTRUCTION ONLY** ' - •''
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
-. - - - : - . .' •:"-. . • ' -. ■'PRO3ECT FLOOR AREAS . . • :. -
•
-• FLOOR - EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL •
-. - ' BASEMENT' •- -- .
' FIRST
SECOND
THIRD
FOURTH ~
OTHER FLOORS(DESCRIBE)
•
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: _
-
Indicate number of each type of fixture _
MECHANICAL
AIR HANDLING UNIT(S) • EVAPORATIVE COOLER(S) . 7GAS 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.( )
INTERCEPTORS) SUMP(S)
- - : --••1111.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(including 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 part of this application.
NAME/TITLE: - f�1 DATE: LIQ Ti ,_
111 PROPERTY OW. ER • APPLICANT ❑ CONTRACTOR
•
:EOR OFFICE USE ONLY:
NEW- --€l=ADDITION ❑-ALTERATION__=!_;REPAIR. -=,❑TENANTiIMPROVEMENT
=CENSUSCOOE:__-17,-;:--i:- _-:•21--
•
•
Ej CiAICAL
TABLE B
•
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
Single Familyl _Service or feeder only 550.00 _ff of Thermostats(First-537.50,add'n-S 11.50ca)
— (First 1300 ft-575.00;Each add'n 500 ftm-524.00) Service and feeder 581.00 ft of Low voltage fire or burglar alarms
-- - - Square Feet:– . - First 2500 ft2-543.50;Each add'n 2500 ft'-S I I SO
_Each outbuildingor garage 531 00 MOBILE HOME/RV PARK Square Feet
- (Inspected with service) Y of service or feeders • l'er WAC 296-46-910(5)(b)(i&ii)
I_ach outbuilding or garage 550 00 (I list service/feeder-5'A 00,Add ii sen i�c/ _ I, 01 Sign,(1 nst sign-S37 30,add ii sign
(Inspected separately) feeder-532 each) 517 50 each)
`,v.inun o,_,pont loot till) ,p,) 5,- 1,)
Yard file meter lo.)p% 550(p1
t•
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or I ceders
Service Feeder Amps Service or Add'n 0 to 200 5 81 00
_Up to 200 amp S 81 00 5 24 00 I ceder 201 -600 18')00'
_201 -400 amp 101 00 50 00 0 to 100 5 81 00 5 50 00 601 - 1000 281 50
_401 -600 amp. . . 138 00 68 50 101 -200 101 00 63 50 over 1000 317 00
_601 -800 amp . 176 50 94.50 201 -400 189 00 75 00 #of circuits
_Over 800 amp . ..252 50 . 189 00 401 -600 220 50 88 50 (1-5 circuits-563 50,Add'n circuits,55 ea)
ALTERED SINGLE/MULTI FAMILY 601 -800 284 50 120 50
(When inspected separately from the services) 801 - 1000 348 00 145 50 TEMPORARY SERVICE
Scrvicc or Feeder Over 1000. 379 00 202 50 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp 5 68 50 _Over 600 volts surcharge 63 50 0- 100 ... . . . .. .5 50 00
201 -600 amp 101 00 Mast or meter repair 68 50 101 -200 63 50
over 600 amp 151 50 201 -400 75 00
Mast or meter repair 37 50 401 -600 101 00
1 S of circuits over 600 109 00
(1-4 circuits-550 00,Add'm circuits 55 ca)
If service is greater than 200 amp a plan review is req'd Fee is 35%of permit fee+563 50 Add'I plan review for other submissions is 575 00/hr
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(I))
Estimated Permit Fee: (12)
Est haled Permit Fee from!me 12
Estimated Plan Review Fee: $63.50 + ( X.35) = (13)
,. ■ DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15) •
:-,:. .- :-,:: .:.�. ::=:- .�• ENGINEERING r- ,r:
•
Estimated Permit Fee:(16)
Bond Amount: (17)_
.`...-'. ..-v . . '''''- "'''''-'...;'''''''...---•':•..:.r';‘. OTHER FEES - ' ••a:= ;•• .- . .
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23) -
Total (Pages ooe&Two): Line(s)(I1)-i(12)4(13)4(14)i(15)•1(16)i(17)4(18)4(19)+(20)1(21)4(22))(23) = (24)___ _ --- -- __- - - _ --
Bulletin #100 1<iiinlry 18, 2001