05-100424 01-28-'05 15:59 FROM-Chubb Security 2065215340 T-304 P02/05 U-770
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F deraiWay PERMIT S- 5—Y? -
COMMIUNITYDEVELOPMENYsaavtr..�s SF MF CO ME �'Y, DE EN FP
13J3a D AVENUE 077x APPLICATION l /
PGDEaA2 WAY, X 9$063-9 718 TO / /
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The allowing is re.uired in ormation-an incom•lete a•.iication win not be acce•ted. Please •rtrt.t le•ibt in ink or I.e.
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i� ,.. 4:01.6;k0-‘"•c PROPERTY INFORMATION
C,7rJ
SITE ADDRESS I -"'? �Q— Ll - SUITE/UNIT#
ASSESSOR'S TAX/PARCEL * - _ LOT SIZE(s)7
s.
LEGAL DESCRIPTION(e.g.Acme Estates, Lot.1) i v'i v , _ AA
/ArmN,separate pays/. tSN3 tag 1 daaonwWo,t)
■ PROJECT INFORMATION
TYPE OF PERMIT D BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION CF(ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
PROJECT NAME(Name of business or Owner Last Name)
• PEOPLE INFORMATION
PROPERTY C PRIMARY PIdONF.
OWNER �� �
MAILING ADDRESS (/ CIS,STA 8t.LJ3
CONTRACTOR COMPANY NAME APPLICANT NAKE OI:PI(;R PHONE
MAILING AC)pM S CITY,STATE,ZIPlS1 LL OPHONE
CITY OP PRDERAI.WAY BUSINESS LICENSE NUMBER F.PIRATION DATE PAX NUMBER
a � -DQ-_ a 2(i) IL/ 31 / O- ) c-1-2i - 53(40
CONTRACTOR'S REGISTRATION NUMBER loopy of card required with each apptkptiorq EXPIRATION DATE
Cr4,2 \gbtgq i3D1 / /
APPLICANT COMPANY ME APPLICANT NAME
OFFICE PHONE
//;;
4\Irt_ 6r,t7..Lkoa ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) '
—RELATIONSHIP TO PROJECT PAX NUMBeR
0 Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE e-MAIL ADDRESS
( ) - _
LENDER .Par RCW 19.27.095: Lender tnformntien fs �.
requfred(fproJeot vague exceeds$5;600
MAIL=ADDRESS CIT,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/,APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINRLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES a NO
WATER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
01-28-'05 15:59 FROM-Chubb Security 2065215340 T-304 P03/05 U-770
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD •
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECI.(COVERED?)
GARAGE 0 CARPORT❑
NUMBER OF FLOORS MISTING gnomon TOTAL TOTAL ISIOSTuuo apr TOTAL PROPOaisn.r TOYAE sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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 FANSHOODS(Commeec„q WOODSTOVEy^
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS (nrTub/Sluwrenmbr) SHOWERS _ WATER CLOSETS mike MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
•
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS Bathroom Suva) _.. VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under pcnatty 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 made by any person,including the undersigned,and flied against the City of Federal Way,but only where such claim
arises out of the reliance of he city, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application, 1
NAME/TITLE Aim DATE V
• -'�,gn (Tina:)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent NR,Contractor 0 Architect 0 Other
FOR OF'FICFiVBE:O,NhY:•.
o NEW o ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES ❑NO BASIC PLAN? ❑YES n NO
ZONING DESIGNATION ORANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? n YES a NO..
PLATTED LOT? o•YES n NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100--Augu,t 19,2004 Page 2 of 4 k\l- i idoutiAParmit Application
01-28-'05 16;00 FROM-Chubb Security 2065215340 T-304 PO4/05 U-770
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/IgDUSTRIAL SERVICE
0 Single Family Square Feet Service. or Feeder Each Add'n
(Firsr 1300 ft2-$87.00;Each add'n 500 ft'-$28.00) 0 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage ❑ 101-200 amp 117.50 74.00
(Inspected with service) $36.50 ❑ 201 -400 amp 220.50 87.00
❑ Detached outbuilding Or garage 0 401-600 amp 256.50 103.00
(Inspected separately) $58.00 ❑ 601-800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) 0 801 1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
0 Op to 200 amp $ 94.50 $ 28.00
❑ 201 -400 amp 117.50 58,00 ❑ 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.
U 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 0 over 1000 amp 369,50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 0 #of circuits to be added/altered
(1-5 circuits-$74,00;Add'n circuits,$6.00/ea)
❑ # of circuits to be added/altered
(1-4 circuits-$S8.00;Add'n circuits$6.00/ea) COM11!ERcjAL/INDUSTRIAL PLAN R VIEW
$74.00 plus 35%of Permit Fee
❑ Mast or meter repair $43,50 0 Service - 1,000 amps or greater
U Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑. Service Over 400 amps
$74.00 piu35%of Permit Fee
MOBILE HOMES
❑ Service or feeder only $58.00 TEMPORARY SERVICE
0 Service and feeder $94.50
Commercial Residential
MOPILE HOME/RV PARK 0 0- 100 $58.00 $51.00
0 # of service or feeders ❑ 101 -200 74.00 51.00
(First service/feeder-$58.00;each add'n-$3750) 0 201 400 87.00
n/n
❑ 401 -600 117.50 nhi
❑ over 600 127.00 nil,
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
(First-$43.50; add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ca)
IX Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s)_J.211_,")� (Includes additional circuit,if required)
Fire Alarm System ❑ 'S('ard Pols meter loops $58.00
Security Alarm System ❑ Additional Plan Review $87.00/ho
CI Voice Cabling (for modified submittals) tlr
❑ Data CaAlinp -
Per System-(s) Ike,500 ft2-$51,00;
Each add'n 2500 f0-13.50) •Per WAC 266-46.9 10(5)(1.0.' ii)
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Bulletin#100-August 19,2004 Page 3 of 4 k\Nundouts\Permit Application