04-105071 r 1
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F€deralWayply 11 PERMITOPL
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CO WNITYDEVELOPMENTSERVICES 7*6' SF MF CO ME DE EN FP
33530 FIRST WAY SOUTH• 6 BOX 9718 �j . . PLICATION TO
FEDERAL WAY,W.4 98063-9718 �. ',�: � / /
253-661-4115.FAX 253.661-4129
iw w.dtuoffedemlulml.corn
`( OF . G DEP''
The ollowin• is re. '• 7• nation—an Inco •lete • • •lication will not be acce• d. Please •rint le•ibl (in ink)or I. .
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PROPERTY INFORMATION
SITE ADDRESS i q i L' S 14 3-t 7 1h FL ederra rY 4-il SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# — _ _ _ _ LOT IZE(sf)
LEGAL DESCRIPTION (e.g.Acme Estates, Lot 1) Lot- Da-61=e45 t`es icte4'i , )
(Attach separate page for lengthy legal descrrpaanl N c-- :: I CI t/p_
PROJECT INFORMATION • 1_ 6 1
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION !(ELECTRICAL 0 ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onhi)
1a5 amp Sub -Pane,' for Rerr,.oti 'I Wir(i3_ fvr aemode-I o/ SFP--
aAd 1-0w MI'f yv I r!✓uj l - rc-i- & - 04-IA, A1A J Pru&I re)
PROJECT NAME(Name of Business or Owner Last Name) Prot/1.0(4.1-1-• E l u h-i c. l vZ G
PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER Lynn E. Dail tel.5 (0253)6/q/ -70(04
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Prov aunt Ecc-f rcc- int, l2ct rcvi 0.531 toL l - '116-0
MAILING ADDRESS C ,STATE,ZIP CELL PHONE
P O Zox 61 ,1g,-1 p , INA °18058 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
— B L / / X253/) u 1I'( -7764
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each appiicatio EXPIRATION DATE
PP. oVi e ) 1030 0
36? / ad, /04.
APPLICANT COMPANY NAME APPLICANT N M �1 I V OFFICE PHONE _
MAILING ADDRESS CITY,ST E,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Descrih ) ( ) -
CONTACT NAME KO- ZA (0153)H N, E-MAIL ADDRESS
.S( - -1 1 70
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? C YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? C YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE C TACOMA C PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE C 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=STENO TOTAL PROPOSED TOTAL ffiDT1S°.um PROPOSED
"*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.
MECHAMCAL
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/ShowerCombo) SHOWERS WATER CLOSETS(rowett MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks, _ VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
1 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, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application. I f /
NAME/TITLE C`� m C�,�(/ DATE I Z'/ /
(5/ 0i
(Signature) (Title(
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent 0 Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
c NEW c ADDITION c ALTERATION c REPAIR c TENANT IMPROVEMENT
BU LDING SHELL ONLY? c YES c NO BASIC PLAN? c YES c NO
ZONING DESIGNATION CHANGE OF USE? =YES c NO
NEW ADDRESS REQUIRED? c YES c NO I UP/SEPA/SII? c YES c NO
PLATTED LOT? c YES c NO ( DEMO PERMIT REQUIRED? c YES c NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
0 Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) 0 0 to 100 amp $ 94.50 $ 58.00
O Detached outbuilding or garage 0 101-200 amp 117.50 74.00
(Inspected with service) $36.50 0 201-400 amp 220.50 87.00
O Detached outbuilding or garage 0 401-600 amp 256.50 103.00
(Inspected separately) $58.00 0 601-800 amp 332.00 140.50
NEW MULTI-FAMILY(three units or more) 0 801 - 1000 amp 405.50 169.50
Service Feeder 0 Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
O 201 -400 amp 117.50 58.00 0 Over 600 volts surcharge $74.00
O 401 -600 amp 161.00 80.00 0 Mast or meter repair $80.00
O 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
O Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY 0 0 to 200 amp $ 94.50
O 201 -600 amp 220.50
Service or Feeder
0 601 - 1000 amp 332.00
0 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50 ,
O over 600 amp 177.00 0 #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
#of ctr I�fi s to be adde el-'-
(1-4 circuits-$58.00;Add'n circuits$6.00/ea) COMMERCIAL/INDUSTRIAL PLAN REVIEW
$74.00 plus 35%of Permit Fee
O Mast or meter repair $43.50 ❑ Service over 200 amps
O Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
O Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
O Service or feeder only $58.00 TEMPORARY SERVICE
O Service and feeder $94.50
Commercial Residenrnl
MOBILE HOME/RV PARK 0 0- 100 $58.00 $51.00
O #of service or feeders 0 101 -200 74.00 51.00
(First service/feeder-$58.00;each add'n-$37.50) 0 201 -400 87.00 n/a
❑ 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
0 #of Thermostats 0 #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
'Low Voltage .J J ;.5, 0 Swimming pool/hot tub $87.00
Square Feet to be served by system(s) I �`LJ (Includes additional circuit,if required)
❑ Fire Alarm System 0 Yard Pole meter loops $58.00
❑ Security Alarm System 0 Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0
(Per System(s) 1u 2500 ft=-$51.00;
Each add'n 2500 ft2-13.50) •Per WAC 29646-910(5)110 5 u)
Bulletin#100-March 30,2004 Page 3 of 4 k\Handouts-Revised\Permit Application