05-100137 RECEIVED BY 0 S - (0O (3 7-- 0 OG
COMMUNITY DEVELOPMENT DEPARTMENT
�, JAN 122005MMUNITYDEPELOPMEIVI'SERV
MSJO FIRST wAr swat•so DDE 9718
FEDERAL WAY,WA 980614718
Fe
FeWay PERMIT APPLICATION
deral 2Si66141MFAX:2046141?9
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0 - 10013 ? m°�°`""OW FW File Number. - 0 a L_____
The o ilowin• is re•wired in ormation-an Inco •lete a••iication will not be acce•ted. Please •rint le•ibi (in ink)or J. ,
'a' ;::'.4.?- , t ? ,a .r_`.:z ` +' ,, r:14=I'• is FROPERTYINFORMATION';:-;;•-1.7...-"..:i.;‘,.- .. . :• ,
SITE ADDRESS: 1lki� JW �`�,_lC5' ,)\ p Alkl4,00 kn SUITE/APT i
ASSESSOR'S TAX/PARCEL#: , �J 0\ 4 10 - 0 V SQUARE FOOTAGE OF LOT: 7 >l.i F'
LEGAL DESCRIPTION(e.g.:Aane Estates,Lot 1) 1 U(2)1 L►-IYY-E
(Attach separate page for lengthy legal description)
• 4. 5 ".1f t .f,;.y-'A•', b „ ,,.::^,4. ..sC` ,.
'�'.,.,.�..r� -� > � � � . .2;: <�-'',..A.:"...,111�:PROJF.CZ`IIdFOR14�ATI0N��r.. .. = - .
TYPE OF PERMIT(This application): ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
0 ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only): 17- ra
PROJECT NAME(Name of Business/Owner Last Name):
vvr.(:*1: -I rs C .: f` ti J.Z fe) J-J .: _t: 1� .,1
ain�..�: _ ,:�c. � .-t'r ...T. °i . c.i�+' r?fi7�i:I1E0PILE�NFORIVTATIOhT �--. ... .. .. .. .-.
PROPERTYNAME: . PRIMARY PHONE:
OWNER: Sf�+tk,i(Iv k1%TM ..14 (, (')ij ) y =Al I
. MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
V5 tO Sbu,A'h tjaVic'►( NA 111 t Ik1(.iO t G. W YV
CONTRACTOR: NAMECOMPANY OFFICE PHONE:
Ikucittu ((;1k. .LiA , sAtI.,(, (-)9/) Cyy ->>t l
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE:
ab()1 Vo c,NA. IA-�r-Yt 10 ( ) -
CITY OF FEDERAL WAY BUSIN LICENSE NUMBER: EXPIRATION DATE: . FAX NUMBER:
1 q�- aq -3 0 '1 1 L ct- / / (`>)cY\ -r'loi1
CONTRACTORS REGISTRATION NUMBER: to
yI / ` (� y�A (,, EXPIRATION DATE:
(copy et card. eL.d with each application)h L I I T 3.� — "i A ,`l tL 1)-i 1 1 I o Lt
LENDER: NAME: DAYTIME PHONE: \\
inPrep.•.aValue'11.5.0001n1'`S.000I ( ) -
MAILING ADDRESS(STREET ADDRESS;): CITY,SPATE,ZIP
APPLICANT: NAME: COMPANY OFFICE PHONE:
MAIUNG ADDRESS(STREET ADDRESS): CITY,STATE.ZIP EVENING PHONE:
( ) • -
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑Architect 0 Tenant 0 Other(Desaibe): ( ) -
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner ❑ Contractor 0 Applicant E-MAIL ADDRESS:
. .. . ■ DETAILED BUMDING INFORMATION '' .
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: O YES O NO
WATER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑LAKERAVEN a 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 warms TOTAL PROPOSED TOTAL EXISTING AND PROPOSED -
"NEW HOMES ONLY" NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
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.
MECEANICAL
Value of Mechanical Work $
--AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(Commercial( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
_ OMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo' SHOWERS WATER CLOSETS(ram MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAYS(B.rbsoem Sink VACUUM BREAKERS ELECTRIC WATER HEATERS
I. 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. '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,
including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
i �
NAME/TITLE: h - DATE:
(Si ture) (Title)
RELATIONSHIP TO PROJECT: ❑ Property Owner i Applicant ❑ Contractor ❑ Architect ❑
4 x:
.43 W a p ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT .
„#UII-''DIING HELI ONLY? o YES o NO. BASIC.PLAN? a YES
ZO
)fitGVESIGNATION - ':' CHANGE;OF USE? q TES o�NO_
NEW ADDRESS REQUIRED? a YES a NO IIP/SEPA/SU? o YES o NO
'PI:ATTED Lot? ' a YES a NODEMO`PERMIT REQUIRED?
a YES a N0
Page 2
' • ■ ELECTRICAL PERMIT INFORMATION . .
• f
RESIDENTIAL COMMERCIAL
•
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet: 100 amp 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) ❑ 0 to $ 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 ❑ 401-600 amp 256.50 103.00
(Inspected separately) $58.00 0 601-800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) ❑ 801-1000 amp 405.50 169.50
Service Feeder ❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
❑ 201-400 amp 117.50 58.00 ❑ O1er 600 volts surcharge $74.00
❑ 401-600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
Cl 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 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 0 over 1000 amp 369.50
Cl 201-600 amp 117.50
❑ over 600 amp 177.00 ❑ #of circuits to be added/altered
(1-5 circuits-$74.00;Addh circuits,$6.00/ca)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
•
. ❑ 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
❑ Service or feeder only $58.00
❑ Service and feeder $94.50 Commercial Residential
❑ 0-100 $58.00 $51.00
•MOBILE HOME/RV PARK 0 101 -200 74.00 51.00
❑ #of service or feeders 0 201-,400 • 87.00 n/a
(First aervioe/Ieeder-$58.00;each addh-$37.50) .
❑ 401-600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
U1 #of Thermostats ❑ #of Signs -
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
❑ Low Voltage 0 Swimming pool/hot tub $87.00
Square Feet to be served by system(s): (Includes additional circuit,if required)
❑ Fire Alarm System 0 Yard Pole meter loops $58.00
❑ Security Alarm System ❑ Additional Pian Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
(Per System(s):1A 2500 ft2-$51.00;
Each add'n 2500 fri-13.50) •Her WAC 296-46-910(50)6 A til
t
Sullelu}#I90 -January 1.200-1 Page 3