02-105583 ;or c CONSTRUCTION PERMIT APPLICATION
uV f� L APPLICATION NUMBER: QZ - /Q.rtr.' -
APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
**The following is required information-Please print(in ink)or type**
IPlease note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
•
SITE ADDRESS: .3 6 l ( 1 /(L e , -Co- ASSESSOR'S TAX/PARCEL#: l'ii Z w V- Qt,O
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
I A-4-.✓ r . ( i,-.)al 1-(;)1., S cf.,c a l
1
-rig: ' I PRO]ECT INFORMATION-. - ... .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMO •■ e
® ELECTRICAL ❑ ENGINEERING❑ FIRE PREVEN e • SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
—°SCJ Ua Naye_ Coy ( W, ,i_ y4 r u E.w. � ' yi?o Nczc���„e et,1 � 1 ,.,,, r
0 la, itY
PROJECT NAME: Nz ‘") rc f l acc.' fr(91l 5' C1,•cT(
• • PEOPLE INFORMATION
r
PROPERTY OWNER: NAME:
DAYTIME PHONE:
1..e «l tjay. sLI� -1)/-1-.--f--0/ -1)/-1-.--f-- (.
MAILING ADDRESS(STREET ADDRESS; ,STATE,ZIP):
- - -iiti•s-��.iwiciiardionf -
Y CONTRACTOR: NAME: DAYTIME PHONE:
714 e+co (4 c _ (z c3)e7/4 - -S6SMAILING ADDRESSAD (STREET ADDRESS;CITY,STATE,ZIP): ,4-F- A-78Q //.9s3 7r-EVENING PHONE:
(7/OFE R BUSINESS<1. LICENSE / 5-e_ ' /p/'/..3s/- rvtryGj<4, 1._✓, ( ) ��•-_
NUMBER: FAX NUMBER:
- - (z S ) 84/7 -g2(C
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(Copy of card d) ``? E T c. o 1 0 Q 3- (s' (,t 01 / 0) / 0 q
APPLICANT: NAME: DAYTIME PHONE:
Jre�, -t— IM..-e�--(-c (i Pr-r_ s,',,t2..,..± ( ) 5--, -
MAILIADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
5-4,,"--L-4.---
( ) t(-
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT '® OTHER(DESCRIBE): GoK " -C* ( ) L -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ia CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
I PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
I SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
1 SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHUNE ❑ PRIVATE(SEPTIC)
**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: y�
�a�FtA�URES•x:.. +e-N��iwF.:.e..+.+.�.r.,�.+eciy .,»i _•m*sr-i+.+ei-a..n+w...ie-..�,r.v OrOf an,�
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS 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.( )
INTERCEPTOR(S) SUMP(S)
■ 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: :.??4".(-1" DATE: Z-7�0 2
❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
tiFOROFFICE USE ONLY
NEW ❑ADDITION; , ,,C ALTERATION #REPAIR N TENANT3IMPROVEMENT
,CEN$USOUDE
ZIG� TGAT O4 xWINS`g I _N
INEStNO
_
COMP _gI) SIGNATION " T *_
ECTION r a s; s ' mss - Tsx, w #m o+v-sg '-O,-.,�
<.,.,.. TOWNSHIP ,, ;�;�RANGEx ,¢_ �NEW�DDRESS REQUIRED?=�_,� �,-;�YES=�„�,•❑;f`f0.�_-,
P 7TED LOT? _ XES NO CHANGE OF USE? ` -_ .[I YES? `F13,;NO ,- __ ."M;
ODMMUNrY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718.253-6661-4000•FAX:253-661-4129
www.cltvolfederalway.com
■-ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $50.00 _p of Thermostats(First-$37.50;add'n-$11.50ea) '
(First 1300 ft2-$75.00;Each add'n 500 ft2-$24.00) _Service and feeder $81.00 At/of Low voltage fire or burglar alarms
Square Feet: First 2500 ft=-$43.50;Each add'n 2500 ft-$11.50 1
_Each outbuilding or garage $31.00 MOBILE HOME/RV PARK Square Feet: Ili `//�3
(Inspected with service) _#of service or feeders *Per WAT 7/96-46-910(5)(b)(i&ii)
_Each outbuilding or garage $50.00 (First service/feeder-$50.00;Add'n service/ _#of Signs(First sign-$37.50;add'n sign
(Inspected separately) feeder-$32 each) $17.50 each)
_Swimming pool,hot tub,spa $75.00 .
_Yard Pole meter loops $50.00
i
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL !
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200 $ 81.00
Up to 200 amp $ 81.00 $ 24.00 Feeder _201-600 189.00
_201-400 amp 101.00 50.00 _0 to 100 $ 81.00 $ 50.00 _601-1000 284.50
_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 (t-5 circuits-$63.50;Add'n circuits,$5 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
Service or Feeder _Over 1000 379.00 202.50 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp $ 68.50 _Over 600 volts surcharge 63.50 _0-100 $ 50.00
_201-600 amp 101.00 _Mast or meter repair 68.50 _101-200 63.50
_ovcr 600 amp 151.50 _201-400 75.00
_Mast or meter repair 37.50 401-600 101.00
_
#of circuits _over 600 109.00
(1-4 circuits-$50.00;Add'n circuits$5 ea)
If a new or altered commercial service is 200 amps or greater,or a new or altered residential service is greater than 400 amps,a plan review is required.Fee is 35%of
permit fee+$63.50.Add'!plan review for other submissions is$75.00/hr.
FIXTURE iDESCRIPTION'(A) FIXTURE FEE FROM TABLE B(B) I4UMBER:OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D): 1
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50+( X 35)=(13)
■ DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
■ ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
i ■ OTHER FEES
Mitigation Fee:(18) (20) (22)
SBOC Surcharge:(19) - (21) (23)
EOtal(Pages one&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)= (24)
Bulletin#100-February 19,2002