03-103069 City Federal Way
Community Development Services Electrical Permit #:03 - 103069 - 00 - EL
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: CHIROPRACTIC WELLNESS&REHAB CLINIC
Project Address: 34211 PACIFIC S Parcel Number: 202104 9053
Project Description: Add new circuits for X-Ray machine,GFI circuits,&hot water heaters. Ad tom( Liv -21`81).1W
Owner Applicant Contractor I
lc
CHIROPRACTIC WELLNESS&REHAB CLIP ELECTRICAL WIRING ENTERPRISES INC ELECTRICAL WIRING ENTERPRISES INC
CLHIROPRACTIC WELLNESS&REHAB ELECTRICAL WIRING ENTERPRISES INC
CLINICS PS PO BOX 834 ELECTRICAL WIRING ENTERPRISES INC
PO BOX 834
33400 PACIFIC HWY S SUITE 2 VASHON ISLAND WA 98070 (206)567-5776
EDERAL WAY WA 98003
Electrical Fixtures
WilUi! ' : _s_ _ ..1 !. _.. ._. plol'lk q ;..,,.,i Qui,* l 3 11 i rt.
MVO
Circuits- Commercial 5
PERMIT EXPIRES January 21,2004.
Permit issued on July 25,2003
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: f".; Date: 74,57d3
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�3 _ CONSTRUCTION PERMIT APPLICATION
LF
CITY OF ®''*++� RE. 1.1 F-P APPLICATION NUMBER: 03— 1 0301:4 -
Federal Way APPLICATION NUMBER: -JUL ' APPLICATION NUMBER: - -
**Theeelld/ (is.required information-Please print(in ink)or type**
BUILDINr, -v-r:
Please note: Electrical, Fire Prevention ' tJms and Engineering permits may require a separate application.
''d'.PROPERTY INFORMATION .
SITE ADDRESS: 4-Z_I I Ar— 116.4*-7 SASSESSOR'S TAX/PARCEL #:� C . 1 0 -I - g o 55
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
., . VI PROSECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MECHANICAL 0 DEMOLITION
giELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
PROJECTDESCRIPTION(Provide detailed description): CO iNe l.J C t r C M,f$ L I r V. Ck•) l `c c�L.
aEJ C,rc.iA,'"-t 5 t-lef Wafer Pe41,1 (ovk ijet rekai( ,ce +6 C4;.-o ,rcif.'c
6. Ze►-,42 CIivtc)
PROJECT NAME: C‘nt1(OQ(O.G'ICL4' \ v\es w. \—��A Ceh4-Q.✓
PEOPLE INFORMATION- .
PROPERTY OWNER: NAME: : DAYTIME PHONE:
C .r 6R igc4r,c �ekk v,ess 'i'- 'I---e-1,. . 1 ( ) -
MAILING ADDRESS(SIRE ADDRESS;CITY,STATE,ZIP):
334(70 Gr. Nwy 5, 5,,fc �eI&ra1 05 Wk. 9$063
CONTRACTOR: NAME t \ An • 1 DAYTIME PHONE:
L9V 'e C4/;C G' "�tr� �By()yr `7 5 ..L tA(1 (2d6 ) c1Q 2 -612/
M NG,AADDDR S(STREET ADDRESS;CITY,ST ,ZIP): I. EVENING PHONE' �y
/I CITY F FEDERAZSAYOBUSINESS LICENZLk
N BER: SL �g0� �e6FAX MB)SO
-y `�a
' AiI ur 7f 4o L(_ * - - 1 ( )
CONTRACTOR'S REGISTRATION NUMBER: I EXPIRATION DATE:
(copy of mrd required) E L, . C I (t 1 1 S N & 61 / 08 165
APPLICANT: NAME: DAYTIME PHONE: -
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE'
( )
RELATIONSHIP TO PROJECT: j FAX NUMBER:
o ARCHITECT o TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT KCONTRACTOR
_ rt. DETAILED BUILDING INFORMATION -
EXISTING USE: _ EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? a YES It NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES t$-NO
WATER SERVICE PROVIDER: o LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION ONLY**
, NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIR
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: 0 ELECTRIC D GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) _ WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTORS) MP(S)
rg. 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(induding costs,expenses,and attorneys'fees Incurred in 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 claim arises out of the reliance of the city,induding its officers and a ployees,upon the accuracy
of the information supplied to the dty as a part of this application. 2 2
NAME/TITLE: C% 45/1.64-1'
DATE: 7 3 0 3
❑PROPERTY OWNER ❑APPLICANT ❑CONTRACTOR
,FOR.OFFICE.USE ONLY:;-
` NEW ��l AD[2ITION` .a ALTERATION Vis„ I ��' Y OOk,_: ,...
''t7.. �REPAIR��.:fib„TENANT IMPROVEMENT,,, r
YCENSUS'CODE:` , „_ ,.+ r LOT SIZE:. N, ,-U „� ` , s 4i :4.
'ZONING DESIGNATION, ' * ”` r .,:::
,:<>..,.,> , . _. � n-�- .._�:#. ��,-���l3UILDING SHED:ONLY'7� DYES �-.❑NO
;COMP PLAN DESIGNATION
SECTION, TOW.NSHIP_ RANGE� ?� NEW ADDRESS REQUIRED?. . .,'o YES , o'NO
PLATTED LOT? r ❑YES a NO . * CHANGE'OF USE? ~ , , n YES 'iJ NO ,
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cityoffederalway.com
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST'BE VERIFIED BY CITY STAFF„EBS6ft TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)$1.00 to$500.00 (1)$30.00
(2)$501.00 to$2,000.00 (2)$30.00 for the first$500.00 plus$1.00 for each additional$100.00 or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$90.00 for the first;2,000.00 plus$15..00 for each additional$1,00000 or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$504.00 for the first$25,000.00 plus 113.00 for each additional S1.000.00 or fraction thereof,to and
Including$50,000.00
(5)$50,001.00 to$100,000.00
(5)$829.00 for the first$50,000.00 plus 19OO for each additional$1,000.00 or fraction thereof,to and
including$100,000.00
(6)$100,001.00 to$500,000.00
(6)$1,279.00 for the first$100,000.00 plus 17.00 for each additional 1L070.600r fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$4,079.00 for the fist$500,000.00 plus$6.07 for each additional$1.000,00 or fraction thereof,to and
Including$1,000,000.00
(8)$1,000,001.00 and up
(8)$7,079.00 for the first$1,000,000.00 plus 54.50 for each additional SLOOrI.Lnor fraction thereof.
Bold number is the base fee for the specified Increment
Jtalidzed underfined number Is the fee per additional svedffed Increment
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District#39 surcharge,commerdal only.
Add$4.50 for WA State Building Code Coundl,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are calculated separately**
• BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
• • MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
• ■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
• PLUMBING
Base Fee Number of Fixtures
$26.00+{ X$9.00/fixture}= (8)Estimated Permit Fee
Estimated Permit Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10) = (11)
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $57.00 _ft of Thermostats(First-$43.00;add'n-$I3.00ea)
(First 1300 ft2-585.50;Each add'n 500 ft -$27.50) Service and feeder $93.00 _ft of Low voltage fire or burglar alarms
Square Feet; _ First 2500 f17-$50.00;Each add'n 2500 ft`-$13 00
_Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) fl of service or feeders *Per WAC 296-46-910(5)(b)(i R ii)
_Each outbuilding or garage $57.00 (First service/feeder-$57.00;Add'n service/ _#of Signs(First sign-$43.00;add'n sign
(Inspected separately) feeder-$37 each) • . $20.00 each)
Swimming pool,hot tub,spa $85.50
II Yard Pole meter loops 557 0(;
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIA! COMMERCIAL/INDUSTRIAL
(Includes three units or more) - Altered Service or Feeders
Service Feeder Amps Service or Add'n 0 to 200 5 93.00
Up to 200 amp $ 93.00 $ 27.50 Feeder _201 -600 216.50
201 -400 amp 115.50 57.00 0 to 100 5 93.00 5, 57.00 601 - 1000 226.50
-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 ..7-14 of circuits
_Over 800 amp 289.50 -- 216.50 _401 -600 252.50 101.00 i 1-5 circuits-$72.50;Add'n circuits,S6 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 !I
_over 600 amp 174.00 ,o 201 -400 85.50
_Mast or meter repair 43.00 401 -600 1 1550
a of circuits 1 _over 600 125.00
-
(1-4 circuits-S.57.00;Add'n circuits SO 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+$72.50.Add'I plan review for other submissions is$85.50/hr.
FIXTURE DESCRIPTION(A) I FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
I }t
11
i
TOTAL COLUMN(D): ,
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $72.50+( X.35) = (13)
■ DEMOLITION - , -. -•
Estimated Permit Fee: (14)
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)s-(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100-December 23, 2002