05-101173 I City of Federal Way Electrical Permit#: 05 - 101173 - 00 - EL
-Community Development Services
P.O.Bbx 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-3050
Project Name: JACK IN THE BOX
Project Address: 31130 PACIFIC S Parcel Number: 785360 0186
Project Description: Hook up new pole light using existing 240-volt circuit
Owner Applicant Contractor
JACK IN THE BOX SIGN-TECH ELECTRIC SIGN-TECH ELECTRIC
18161 SEAGLE PARK B SIGN-TECH ELECTRIC SIGN-TECH ELECTRIC
33759 9TH AVE S 33759 9TH AVE S
\TUKWILA WA 98188-4775 FEDERAL WAY WA 98003
Electrical Fixtures
Description Quantity Description Quantity Description Quantity
Circuits- Commercial I 1
PERMIT EXPIRES September 10,2005.
Permit issued on March 14,2005
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the us- ' 11 be in accordance with the laws rules and regulations of the State of Washington and
the City of Federal a'
Owner or agent: /' Date:
FINALED
o)
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THIS CARD IS TO REMAIN ON-SITE
CITY OF ,A, Community Development Inspection Record,
Federal Way IVR INSPECT1tN REQUEST PHONE # (253) 835-3050
PERMIT #: 05-101173-00-EL
Owner: JACK IN THE BOX
Address: 31130 PACIFIC HWY S
FEDERAL WAY, WA 98003-4905
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
0 Slab/Concrete Floor(4255) .❑ Ditch cover(4030) #❑ Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By T5 Date 3.—x3._,&:1 -------By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) 0 Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved Approved
By Date By Date B tja> Dated-Z' -0
❑ Under-slab groundwork(4295)
Approved
By Date
4
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Federal ►CEI\/E[J p I' E�EIVEDI__---
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COMMUNITY DEVELOPMENT SERVICES
ERM SF MF CO M EL L DE EN FP
33325 FBTMRALWA ,WASOU9•POBOX91 AppLICATIrk
FEDERAL 07Y,FAX
9 8 4 2005
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253-835-2607•FAX 25309� 4 2005
wwwci t yofederal wa u.corn
AL WAY
The ollo . _�, •;, a_J •tion-an inco .tete a•.lig& c• , L_•!_; e•ted. Please .Tint le.ibl (in in or .
�y
1111 PROPERTY INFORMATIONr
SITE ADDRESS JJ 1 ` gaC \C_ \-4w"\ S- SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - — _ LOT SIZE(sf)
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 yELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
K /0 Se `\ ' - c c ' -eA(‘3k)',nO 4O—Vo)-J
_ ecu
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\ VIP_
PROJECT NAME(Name of Business or Owner Last Name)yAC K LI, C
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR PANY NAME p� APPLICANT NAME OFFICE PHONE
6.
itC4
AR S I Aye
CITY, ' Q I GOC4-f 1 i ELL PHONE
)ENS� -Li( /4i
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER �C�� EXPIRATIO_t DATE FAX NUMBER
- - - / / (ZS)` - \ J �
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
4y\} -, ( ) -LING ADDRESS \ ) / CITY,STATE,ZIP - CELL PHONE
\
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT ^1 / Aen ^�L4I PRIMARY
PHONE
IJME,R5 -�5fCk E-MAIL ADDRESS
LENDER , , o oNAME
,ao.:- J:1,16;,Lue exceeds 5 MR
MAILING ADDRESS CITY,STATE,ZIP
M DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES 0 NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL) f,,
SEWER SERVICE PROVIDER 0 LAKEHAVEN a 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 0 CARPORT❑
NUMBER OF FLOORS
EXISTING PROPOSED toTAL TOTAL TJUSTO°sr TOTAL PR°POBm sr TOTAL SP
" _
**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(folk) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sink.) 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 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,includi g its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. /
NAME/TITLE / C� r VO DATE l I�V�J
T Jue) (Title)
RELATIONSHIP
Owner 0 Agent Contractor ❑ Architect 0 Other
e ear
f m� a DITION AT.I'ERATION REP LIlt� x �r TENANT IMPROVEMENT
j ' SHELLY? YE =4b IBASIC PJANGE gF?UE YYEESS a
Ni07 , IGNION iZ
+re a s. UIRED? 44114'"‘.
NO UP/SEPAJSU?'`$ '���. o YES{,, O
r D ° . p . -DEMO ERMIT QUIRED? �"WYES e j Q
Bulletin#100—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
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MEMIIMM=1MMEMNIIIIPM.F.-
FORMATION
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 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
❑ 0 to 200 amp $87.00
❑ 201 -600 amp 141.00 ❑ #of circuits to be added/altered
❑ over 600 amp 212.50 ( -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) CommerciaVlndustrial 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 ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System ❑ Yard Pole meter loops $104.50
❑ Security Alarm System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
O Data Cabling
❑ ❑ Automation Fee on all Permits $5.00
(Per System(s) 1•t 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) *Per WAC 296-46-910(5)(6)(i&ii)
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application t