04-104692 City of Federal Way Electrical Permit #: 04 - 104692 - 00 - EL
Community Development Services
P.O.Box 9718
Federal. 25Way,WA 98063-(253 Inspection request line: (253) 835-305C
Ph:(253)835-7000 Fax:(253)835-2609 � 11 q
Project Name: 7-11 STORE 27284
Project Address: 32935 1ST 3 ASC$ Parcel Number: 182104 9037
Project Description: Altering/extending(1)circuit for new donut display case
Owner Applicant Contractor
KORNBLAU LOUIS&SON INC MADSEN ELECTRIC MADSEN ELECTRIC
376 EL ENCANTO DR 3939 S ORCHARD ST 3939 S ORCHARD ST
PASADENA CA TACOMA WA 98466 TACOMA WA 98466
91107-5308 \ (253)383-4546
Electrical Fixtures
Description 1Quantity Description Quantity r Description Quantity
Circuits- Commercial I
PERMIT EXPIRES May 17,2005.
Permit issued on November 18,2004
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the Taws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent: ^"^�I Date:
FINALED ,\(
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y
THIS CARD IS TO REMAIN ON-SITE a
CITYOF ACommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-104692-00-EL
Owner:
Address: 32935 1ST AVE S
FEDERAL WAY, WA 98003-6304
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.
O Slab/Concrete Floor(4255) ❑ Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
O Rough Electrical(4225) 0 Ceiling Cover(4020) Final-Electrical(4055)
Approved Approved Approved
By Date By Date By GS Date//— --V
El
❑ Under-slab groundwork(4295)
Approved
By Date
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COMMUNITY DEVELOPMENT SERVICES PERMIT S F MF CO M EL L D E EN FP
33325 8*"AVENUE SOU771•PO BOX 9718
FEDERAL WAY,WA 98063-9718 APPLICATION !I'D / /
253-835-2607•FAX 253-835-2609
wwwa t tlof ederaituo q.com
The following is required information-an incomplete ap.lication will not be acce.ted. Please .rint legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 3 i3S < /vim 1 / 'd.Lui,
j 9Yo(j 3 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ LOT SIZE(sj7
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 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJACT DESCRI (Provide tailed description of wo included on thispermit onl
- Q • p SCJ 11.SF-
44- Al Li
PROJECT NAME(Name of Business or Owner Last Name) 7--/ �JC.Ov-
1 e- p[.]pZ�
PEOPLE INFORMATION
PROPERTY NAME
7 - PRIMARY PRIMARY PHONE
OWNER ( )
MAILING ADDRESS _ CITY STATE P
3.71 35 1 ,7CJ,4 W S- Fed l4.)4- gFoa 3
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
P14 DS'Eit) elr,cr./2A'd. S R-- & ( as 3 83 '/s y4
MAILING��^^ ADDRESS
/ 111K CITY,STATE,ZIP CELL PHONE
e?q3 9ERAL WAY BUperSINESS SE NUMBER 7 2 r 69,1-pt ATION 92-'16DATE ( 53) /
g `,[J
3 4 4
FAX NUMBER
- - - B L /
/
(as.S[p/f 604/9
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each applications EXPIRATION DATE
rnRD S_ E L t_ u PA / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
)/�� (
61114/1(
a 1,•'V . , MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
p(30ve ( )
RELATIONSHIP TO PROJECT - FAX NUMBER
0 Architect ❑ Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT �1 PRIMARY PHONE E-MAIL ADDRESS- bIte boit,j jt-(,�
W1
V �J�tai L (as3) 3�3 - gz cc4j �lecne.1 0k
LENDER Per 12CW 119.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION .
EXISTING USE ICP ii-( L PROPOSED USE SP '- S
EXISTING ASSESSED/APPRAISED VALUE $ . VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC) •
.. .
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSU TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
—GARAGE/CARPORT
HOW MANY FLOORS? TOTAL WSTIRG TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
-y F�LLTTURES
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
BIIQS FANS HOODS(coolm<rmal)
W OO DSTO V ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(roan) 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 -
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, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE
(Signature) (Title)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent 0 Contractor 0 Architect ❑ Other
( FOR OFFICE USE ONLY
o NEW a ADDITION a ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES o NO BASIC PLAN? o YES a NO
{ ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? o YES a NO
PLATTED LOT? o YES a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin#100-March 30,2004 Page 2 of 4 k\Handouts—Rcviscd\Permit Application
ELECTRIC A • -j 1 ' e -i 1 . S . .
PI
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
CI Family Square Feet Service or Feeder Each Add'n
(First`1300 ft2-$87.00;Each add'n 500 ft2-$28.00) ❑ 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage Cl 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 ❑ 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
O 201 -400 amp 117.50 58.00
❑ Over 600 volts surcharge $74.00
CI 401 -600 amp 161.00 80.00
ClMast or meter repair $80.00
1 ❑ 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 to 200 amp $ 94.50
❑ 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 3"( ) #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-$58.00;Add'n circuits$6.00/ea) COMMERCIAL/INDUSTRIAL PLAN REVIEW
$74.00 plus 35%of Permit Fee
❑ Mast or meter repair $43.50 ❑ Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
❑ Service or feeder only $58.00 TEMPORARY SERVICE
❑ Service and feeder $94.50
Commercial Residential
MOBILE HOME/RV PARK ❑ 0- 100 $58.00 $51.00
❑ #of service or feeders ❑ 101 -200 74.00 51.00
(First service/feeder-$58.00;each add'n-$37.50) ❑ 201 -400 87.00 n/a
❑ 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats CI #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
CILow Voltage 0 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 $58.00
0 Security Alarm System ❑ Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
(Per System(s) I..2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) •Per WAC 29646-910(5)(L/(&!1/
Bulletin#100-March 30,2004 Page 3 of 4 k\llandouts-Revised\[emit Application
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