04-104569 r ! ,I.
City of Federal Way Electrical Permit #: 04 - 104569 - 00 - EL
Community Development Services
P.O.Box 9718
Ph. Way,WA 98063-(253 Inspection request line: (253) 835-3050
Ph:(253)835-7000 Fax (253)835-2609 P 9
Project Name: FEDERAL WAY GROCERY OUTLET
Project Address: 32945 PACIFIC S Parcel Number: 172104 9068
Project Description: Installing L/V voice,data and paging cabling.
Owner Applicant Contractor
Ray W Strand XETA TECHNOLOGIES,INC. XETA TECHNOLOGIES,INC.
5800 PRINCETON AVE NE 13102 NORTHUP WAY 13102 NORTHUP WAY
SEATTLE WA BELLEVUE WA 98005 BELLEVUE WA 98005
98105-2134 (206)274-7300
Electrical Fixtures
j Description Quantity Description Quantity Description !Quantity
Low Voltage-Other Commercial 3
L
PERMIT EXPIRES May 8,2005.
Permit issued on November 9,2004
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 Way.
Owner or agent: Avi..e. Date: I I - `6 ' 0 L`
O.
Vr) k \
THIS CARD IS TO REMAIN ON-SITE ,• g
CITY... OF ACommunity Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104569-00-EL
Owner: RAY W STRAND
Address: 32945 PACIFIC HWY S
FEDERAL WAY, WA 98003
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) 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) ❑ Ceiling Cover(4020) : i 1 Final-Electrical(4055)
Approved Approved Approved
By Date By Date By` iS Date ��
❑ Under-slab groundwork(4295)
Approved
By Date
, . .
v�[ 04 - l o q 5 co q.
FederalW CO PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF COM EL PL DE EN FP
333258*"AVENUESOUTH•PO BOX971Q p rZOQ4 APPLICATION TD / /
FEDERAL WAY,WA 980 u7
253-835-2607•FAX 253-810
www.cituoffederalwau.com
pF FEDERAL WAY
The ollowi • a r=i l; 4,a,,f rio ' • on-art into •tete a••lication will not be acce•ted. Please •rint le•ibl in in or
• PROPERTY INFORMATIONL ,'
SITE ADDRESS 2 l '"\S f it C, ��w�I J [-C,�'i.-‘..A�./ �
Gcs' SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# LOT SIZE(sf) 1-11t40
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 TRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
I-4 W Grp 14-r4 c, - VC.) «-c__ 1 C r -\-v-)-- Ca Z.). '‘^'t ! p-alu•-)y-Le--
PROJECT NAME(Name of Business or Owner Last Name C r OC Com_(' 4` D,A,# \e-A-
.
e-A-
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
X-eTA- i e-c_1,1,,o(pct < e 5 .3C OA Colewlc:,, (',:)0c..) avti - 730q
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
tc A 1„J. c vv c- Q rokevAttoV , 0 IS (a 06) 9; - Ot)a-1
CIT}OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- B L -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
Y. t-- TFV •T`- 4 6 z 2, / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑ Tenant ❑Agentthey(Describe) CO+1 t - C-ar- ( ) -
CONTACT NAMEPRIMARY PHONE E-MAIL ADDRESS
T' l71C-()erg (206) fly - '73d I
LENDER 7xa s t ,p a NAME
�
MAILING ADDRESS CITY,STATE,
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ _ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES /-6<". FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YESI1 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
tr1
SECOND ( 1
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL �. Y tt
NUMBER OF FLOORS
**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(Toilet) 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 authorised 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.
�JG
NAME/TITLE ✓'Bek2 C '► DATE l///1d
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent Contractor 0 Architect 0 Other
yam:
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Bulletin#100—August 19,2004 Page 2 of 4 k\Handouts\Permit Application
ELECTRICAL PERMIT INFORMATION .
RESIDENTIAL COMMERCIAL •
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder EachAdd'n
❑ Single Family Square Feet
(First 1300 ft,-$87.00;Each add'n 500 ft2-$28.00) ❑ 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage 0 101 -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
❑ 201 -400 amp 117.50 58.00 0 Over 600 volts surcharge $74.00
❑ 401 -600 amp 161.00 80.00 ❑ 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 ❑ 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 ❑ #of circuits to be added/altered
(1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ # of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea)
$74.00 plus 35%/o 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
O Service and feeder $94.50
Commercial Residential
MOBILE HOME/RV PARK ❑ 0- 100 $58.00 $51.00
O If 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 ❑ #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
lo Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) t7 (k.0 0 (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 Celing - ASP
51 PC460.149.
(Per System(s) 1.2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) •Per WAC 29646-910(5kb/(i&ii/
�} OV
Bulletin 0100-March 30,2004 6' Page 3 of 4 k\Handouts-Reviscd\Pernnit Application