03-104212 • 4
City of Federal Way Electrical Permit #:03 - 104212 - 00 - EL
Community Development Services
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: NORTHWEST CHURCH
Project Address: 34830 21ST AvQ, Parcel Number: 542350 0630
Project Description: Low-voltage HVAC controls for(6)units.
Owner Applicant Contractor
CITY OF FEDERAL WAY-PW*FEI TANG* NORTHWEST CHURCH &MIKE LE. EVERGREEN REFRIGERATION INC
33530 1ST WAY S 34800-21ST AVE SW 727 S KENYON
FEDERAL WAY WA P.O.BOX 23085(98093) SEATTLE WA 98108
98003-6210 FEDERAL WAY WA 98023 (206)763-1744
Electrical Fixtures
Description Quantity Description JQuentity Description JQuantity
Thermostat 6
PERMIT EXPIRES March 9,2004.
Permit issued on September 11,2003
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 Way. /
Owner or agent: OrldAA."--rThrl'Ady..rar— Date: /��!��
0 -- !6 =-u 3 k?P "\ Cuv-c rr-oti,e �S
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° - 11-4 - 0 H C L.-4U
O 1 — 1-1- 0 'It .
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®®®1 RECEIVED CONSTRUCTION PERMIT APPLICATION
CITY OF P`V
Federal 1lVa APPLICATION NUMBER: Oa - jQ qct La— - 1
Y S � t 1 2003 APPLICATION NUMBER: 1
CIT F FE P WAY APPLICATION NUMBER: - -
**The follow l a InT]i formation-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
- - ■ PROPERTY INFORMATION
SITE ADDRESS: 3`( � al''' I t1, - ) •ASSESSOR'S TAX/PARCEL #: 5 Id 3 5 15 - 0COO
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SE ARATE DESCRIPTION IF LENGTHY):
t)oc' west 4kucam
■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION
ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): /a h{-co is 6 c 6 i vAL cantk'S
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DA' E PHONE:
vc��, West 0,4c4.1„.0,4c4.1„. (a 3135 -0 3,1e
MAILING ADDRESS(STREET ADDRESS;CITY,STATE ZIP):
3� g.ae, WS-L �0.
CONTRACTOR: I NAME: DAYTIME PHONE:
�Lk dr ee,_ ReiC i?Caki on ; A06)763 - Will
MAILING ADDRESS(STR ADDRESS;CITY,STATE,ZIP): �! �. EVENING PHONE:
-7a7 S 6r vor\ cid, ; ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: • FAX NUMBER:
ao as- ja - ( y53c5o - jL i ( ) -
CONTRACTOR'S REGISTRATION NUMBER: VCR
r (� / Q �j
(copy of card required) e V C Y V R LV 00 5 4 �j 10 EXPIRATION DATE:
/4C.5 4/
APPLICANT: ( NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): EVENING PHONE:
( ) -
RELATIONSHIP TO PROJECT: j FAX NUMBER:
0 ARCHITECT ❑TENANT o OTHER( DESCRIBE): i ( ) -
E-MAIL ADDRESS:
I
CONTACT PERSON FOR THIS PROJECT: O PROPERTY OWNER O APPLICANT CONTRACTOR
- . ■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
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: o 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 perjurythat 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(induding costs,expenses,and attorneys'fees incurred 1n 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 dty,induding its officers and employees,upon the accuracy
of the information supplied to the dty as a part of this application. /
NAME TITLE: DATE: q` a/c,"
o PROPERTY OWNER o APPLICANT ,CONTRACTOR
-FOR.OFFICE.USE ONLY
s
NEW. >ci ADDITION ❑.ALTERATIONS n.REP,AIR.- ci TENANT IMPROVEMENT "
rCENSUSiCODE: `=mss =+ 'LOTSIZE: ' � s
'ZONING DESIGNATIO1 ..: j • ��* BUILDING SHELL�ONLY2 o�YE$Ax
;COil- PfPLAN DESIGNATION >° tBASICPLAN? ❑YES ❑.NO,
`SECTIONS TOWNSHIP: RANGE NEIN ADDRESS REQUIRED? ,.. , ❑YES a NO
PLATTE LOT?'r �YES o N0 ,, .CHANGE;OF USE? c.E,, c YES ''-❑"NO
• OOMMUNDY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
yuww.dtvoffederalway.00m
• TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES pISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $57.00 ft of Thermostats(First-$43.00;add'n-5 13.00ca)
(First 1300 ft'-$85.50;Each add'n 500 ft -$27.50) _Service and feeder $93.00 #of Low voltage fire or burglar alarms
Square Feet: First 2500 ft2-$50.00:Each add'n 2500 ft`-513.00
_Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _#of service or feeders ' Per WAC 296-46-910(5)(b)(i R.ii)
_Each outbuilding or garage $57.00 (First service/feeder-557.00;Add'n service/ _#of Signs(First sign-$43.00;add'n sign
(Inspected separately) feeder-S37 each) - $20.00 each)
Swimming pool,hot tub,spa $85.50
Yard Pole meter loops $57.00
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 5 93.:10
Lip to 200 amp 5 93.00 $ 27.50 Feeder 201 -600 216.50
_201 -400 arm115.50 57.00 _0 to 100 $ 93.00 5 57.00 601 -1000 326.50
=401 -600 amp 158.50 78.50 =101 -200 115.50 72.50 _over 1000 363.00
601 -800 amp 202.50 108.50 201 -400 216.50 85.50 _#of circuits
_Over 800 amp 289.50 216.50 _401 -600 252.50 101.00 (I-5 circuits-$72.50;Add'n circuits,56 ea,
ALTERED SINGLE/MULTI FAMILY _601 -800 326.50 138.00
(When inspected separately from the services.) _801-1000 399.00 166.50 TEMPORARY SERVICE
Service or Feeder _Over 1000 434.50 232.00 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp $ 71.50 _Over 600 volts surcharge 72.50 _0-100 $ 57.00
201 -600 amp 115.50 _Mast or meter repair 78.50 _101 -200 72.50
_over 600 amp 174.00 _201-400 85.50
-Mast or meter repair 43.00 _401 -600 115.50
-a of circuits _over 600 125.00
(1-4 circuits-$57.00,Add'n circuits$6 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+572.50.Add'l plan review for other submissions is 585.50/hr.
FIXTURE DESCRIPTION(A) I FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
j
TOTAL COLUMN(D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $72.50+( X.35) = (13)
• . ■ DEMOLITION , .
Estimated Permit Fee: (14) 1
Bond Amount:(15)
■ ENGINEERING . : .
Estimated Permit Fee: (16)
Bond Amount: (17)
- ■ OTHER FEES
Mitigation Fee: (18) (20) (22) /
SBCC Surcharge: (19) (21) (23)
Total (Pages one&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)t-(18)+(19)i-(20)+(21)+(22)+(23) = (24) i
t , Bulletin #100-December 23, 2002