04-104399 a
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Cityof Federal Way
Community Development Services Electrical Permit #: 04 -`104399 400 - EL
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: NORTHWEST CHURCH
Project Address: 34800 21STSWarcel Number: 542350 0630
Project Description: Install 2 circhlts'-Ave..or new signs;install 2 circuits for site lighting.
Owner Applicant Contractor
NORTHWEST CHURCH TANDEM ELECTRIC,INC TANDEM ELECTRIC,INC
PO BOX 25110 5836 S 228TH 5836 S 228TH
FEDERAL WAY WA 98093-2110
\KENT WA 98032 (253)395-8806
Electrical Fixtures
Description Quantity Description Quantity Description 1Quantity
Circuits- Commercial 4
PERMIT EXPIRES April 25,2005.
Permit issued on October 27,2004
I hereby 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 W: ,.
Owner or agent: 1 Date: /G!
FINALED
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THIS CARD IS TO REMAIN ON-SITE
CITY OF ' Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 04-104399-00-EL
Owner: NORTHWEST CHURCH
Address: 34800 21ST AVE SW
FEDERAL WAY, WA 98023-3044
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 j c,( ) Approved /7.367 c,G/ Approved
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By Date Br pp Date/0,_0 _,),4 By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
,
❑ Rough Electrical(4225) 0 Ceiling Cover(4020) Final-Electrical(4055)
Approved Approved Approved
By Date By Date By/ Date 2(1.-1
O Under-slab groundwork(4295) ,-.c-c0,-__ Co R,,.71--- g ss
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Approved q Drp.r c / {p res-,s-
By
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By Date k e asf- 1-41— via)✓✓ 4,47/1 ••••)7/.
C.
OF 41/1.6A
Federal way RECEIVE[) PERMIT —014. Q � � �
SF MF CO MODEL
COMMUNITY DEVELOPMENT SERVICESL D E EN FP
33325 8r'AVENUE SOUTH•PO BOX 9718
53-835FEDERAL 07Y,FAX
98063-9718-8 -2600 CT 2 7 200 P P L I C AT I O N TD
253-835-2607•FAX 253-835-260 / /
wwwatLol%deraheau.com
The following isCAR6lakIREABRAticWANin incomplete ap.licatiort will not be accepted. Please print legibly(in ink)or type.
�/," I PROPERTY INFORMATION
SITE ADDRESS 1 :1 (.�U •
2 , 4t7e .5 C<J �(Gti: _ Alt c q SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
( LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
i (Attach separate page for lengthy legal deunpaon)
-. ■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION XI,ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT
sDE�SCRIPTION(Provide detailed description of work included on this permit onlu)
_Li ,c (\ r- C t l'G^ -J £Z2'; nez,) .S i , ,AS
_..14-S di1 k` L.-`r Co L. 1 c s I VI tiL.}
PROJECT NAME(Name of Business or Owner Last Name) 1\6 A /\1t^ $"- e h j r c
PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER J•I4)if f k 1rti.L'�'c')- ( ( t\ ,5.3) 3a 3;2
MAILING ADDRESS CITY,STATE,7P
3qh° 5. - !(l, C J -4—
r-e coo rck..I t CA yJ i & �`1
3'
CONTRACTOR COMPgNY NA EAPPLICANT NAME OFFICE PHONE
Jane/ ' 61 C- A ( / I ,)-ci ,/1 c3) 35s - - O6,
MAILING ADDRESS CITY,STATE ZIP CELL PHONE
5- 36, So_ 2,s 4-1s,- jt LJA 9Al2 pa, )S"1/ -c/l
CITY OC FEeRAyBUSINESS LICENSE NUMBER EXPIRATIOND FAX`NUMBER
_ - 4Y- BL 0 / 7 / / ,P -3) 3 ‘ -�O /
9NTRACTOR5 R GISTRATION NUMBER(copy of card r aired with each application) J EXPIRATION DATE -
.
L 6 € e 'L 0 v ' — 0 3 /0 (' / 200C,
APPLICANT COMPANY NAtIE APPLICANT NAME
OFFICE PHONE
'-ra t.1 L�(,,,i-, ( ) -
AILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect 0 Tenant a Agent , [Other(Describe) a), i--,,,.. ,--- ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
( ) -
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 0. � /\•• PROPOSED USE C IA l,,,,rc k
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 31/ ( 5
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YFS ❑ NO
' WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE a TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE a PRIVATE(SEPTIC)
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.EXISTING TOTAL PROPOSED TOTAL EXISTING AND 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.
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(orTub/show,rcombo) SHOWERS WATER CLOSETS troueq 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
'- '5111/SCLAMERISIGNATURE ,
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,includin its officers a employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE (�L�( � yC u/ C�,G�`'(- v/.t /DATE /0' ."ri./ -G/ /
S// re) (Title)
(Signature)
RELATIONSHIP TO PROJECT 0 Owner ❑ Agent ,.Contractor ❑ Architect 0 Other
( FOR OFFICE USE ONLY
a NEW o ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? a YES a NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? ❑YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES o NO
. i a
Bulletin#100—March 30,2004 — Page 2 of 4 k\Handouts—Revised\Permit Application
ELECTRICAL PERMIT INFORMATION .
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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 ❑ 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) CI 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 ❑ 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
o Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY ❑ 0 to 200 amp $ 94.50
0 201 -600 amp 220.50
Service or Feeder 0 601 - 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%of Permit Fee
❑ Mast or meter repair $43.50 0 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
U #of Thermostats ❑ it of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
❑ Low 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
❑ Security Alarm System ❑ Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
O Data Cabling
0
(Per System(s) l•,2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) •Per WAC 29646-910(5)(b/(i&ii)
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Bulletin#100-March 30,2004 Page 3 of 4 k\l landouts-Reviscd\Penult Application