04-104662 City of Federal Way Electrical Permit #: 04 - 104662 - 00 - EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305a
Project Name: AT&T WIRELESS ADELAIDE
Project Address: 1216 SW DASH POINT Rd Parcel Number: 515320 0621
Project Description: Installing 5 circuits to an existing 200 amp service
Owner Applicant Contractor
Charles D Kleier &Mary E Kleier VALLEY ELECTRIC OF MT VERNON VALLEY ELECTRIC OF MT VERNON
44489 TOWN CENTER WAY#D45 VALLEY ELECTRIC OF MT VERNON VALLEY ELECTRIC OF MT VERNON
PALM DESERT CA 1100 MERRILL CREEK PKWY 1100 MERRILL CREEK PKWY
92260-2723 EVERETT WA 98203 (425)407-0832
Electrical Fixtures
Description Quantity Description Quantity Description 1Quantity
Circuits- Commercial If 5
PERMIT EXPIRES May 15,2005.
Permit issued on November 16,2004
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 laws,rules and regulations of the State of Washington and
the City of Federal Wa
Owner or agent: Date: //— / -oK
s
�
\t,'
THIS CARD IS TO REMAIN ON-SITE - " .--
CITY
CITY OF-4A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-104662-00-EL
Owner: CHARLES D KLEIER
Address: 1216 SW DASH POINT RD
FEDERAL WAY, WA 98023-8264
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) .0 Ditch cover(4030) ❑ Pool Bonding(4195)
Approved to place concrete *Li
Approved Approved
By Date By Date ‘‘\\CA04.
By Date
.❑ Temporary Power(4275) �❑ Service(4235) ❑ Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final-Electrical(4055)
Approved Approved iApproved
1
By Date By Date : ,+�\i Date
❑ Under-slab groundwork(4295)
Approved
By Date
•
• a.v c...4,,,,,,-..„, - / � � //
Federal WayVE[� � � � l�
PEI N' ECEo
COMMUNTIYDEVEWPMENTSERVICES SF MF CO M_✓®)PL DE EN FP
33325 8T"AVENUE SOUTH•PO63 BOX 9718 A P P L I C AT o0 N 2004 !►�
FEDERAL 07Y,FAX
93063-9718 TO / /
253-835-2607•FAX 253-835-2609
www a t uofederal ua u.com
IT .OFF 'ER'LWA
The following is required information-an incomplete a..tic•_,4 ) .(�A • ',,- cce•ted. Please •Hat legibly(in ink)or type.
. c ,vV NI PROPERTY INFOR�MATION
S
'
SITE ADDRESS C2 A ? 3o ? . „�VTISUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - — _ — . <
LOT SIZE(4)L
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
Maack separate page for lengthy legal description)
I. PROJECT INFORMATION •
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION'LECTRICAL 0 ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
A Ict w f S C k it G 44--td'5 4o' r•-,, .&x c$1- 2 5 a Ie,(0 t
PROJECT NAME(Name of Business or Owner Last Name) 4-- T-4. t (A..)J F
U PEOPLE INFORMATION
PROPERTY NAME 1
OWNER AT(i-T V V /)/ l(C 5 PRIMARY)HONE
MAILING ADDRESS CCITY,STATE,ZIP -,
CONTRACTOR COMPANY NAME ' APPLICANT NAME OFFICE PHONE
VA- I in' ka(e,fAvtL F ( 42 -3zr -2'fDo
MAILING ADDRESS •., CITY,STATE,21? CELL PHONE
• lIOd ELt (// � rNe �' PPvutv _ , / 03SSZ _82_4 2_•
CITY FEDERAL BUSINESS LICENSE PIRAT GATE FAX
- -0o -1 o L '7 6 g -B L /Z /3( / o ( • ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
L k L _LE E i 4 SNA B /ol / e (
APPLICANT COMPANY NAME ,.,(,+� n/ APPLICANT NAME OFFICE PHONE
Le' iq 11..'Z ( )
IL�DDRESS CITY,STATE,ZIP CELL PHONE
( ) -
RELATIONSHIP TO PROJECT • FAX NUMBER
0 Architect 0 Tenant 0 Agent 0 Other(Describe) ( ) -
CONTACT NAPRIMA�1g Y PHONE E-MAIL ADDRESS
i (2c ) 2jc',- 6 3�
LENDER ¢PerRCW i19 27 X95: Lender information is:. NAME
required ifprojectvalue esceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
- .■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN a HIGHLINE o PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ.FT. •
TOTAL
BASEMENT r
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE CARPORT
TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS?
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIM. ' D SELLING PRICE $
. • T[;RES
Indicate number of each type of fixture to be installed or relo'•te.• as part of this project. Do not include existing fixtures to remain.
• MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EV. '•RATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS F I S HOODS(c......-..1) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING MISC(Describe)
BATHTUBS or Tub/Shower ..m) SHOWERS WATER CLOSETS(roa<q
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTL K. SUMPS RAINWATER SYST
WASHING M • INES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) 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 i�� . /
DATE ! / /6
(Signature) (Title)
S RELATIO 1.. PTO PROJECT 0 Owner pd_Agent ❑ Contractor ❑ Architect 0 Other
E FOR OFFICE USE ONLY -
o NEW o ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT
1 BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
i ZONING DESIGNATION CHANGE OF USE? ❑YES a NO
t NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? 0 YES to NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? o YES 0 NO
•
Bulletin#100—March 30,2004 — Page 2 of 4 k\Handouts—Rcvised\Pcrmit Application
ELECTRICAL PERMIT INFORMATION
•
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) 0 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) 0 801 - 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 Ill %oer 'IS vo . harge $74.00
❑ 401 -600 amp 161.00 80.00 0 Mast or meter repair $80.00
❑ 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY 00 amp $ 94.50
❑ 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
❑ 201 -600 amp 117.50
❑ over 600 amp 177.00 ❑ 5 #of cir s e added/altered
(1-5 circuits $74.00;A d'n circuits,$6. /ea)
❑ # of circuits to be added/altered CO PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
$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 0 101 -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 ❑ #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/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 $58.00
❑ Security Alarm System ❑ Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0
(Per System(s) 1•,2500 ft2-$51.00;
Each add'n 2500 1t2-13.50) •Per WAC 296-46-910(5)(b)(i&ii)
I
I Bulletin#100-March 30,2004 Page 3 of 4 k\Handouts-Revised\Pennit Application