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05-100703 T-- -15-' 5 10:09 FROM-Chubb Security 2065215340 T-470 P02/05 U-236 cIrro� i -� ._ — . 1 Q2 Q3 Federal Way REcEIRERMIT l:0Hh1UN17Y DEP111,01'MBAT SERI'JCJ;S SF MP CO M.��I� PL DE EN x P :i.3335 8711 A1'EA47F.SUM/•PO ROI\971k PLLL WAY,W.-1 48063FE Q ?5Ir I C AT I O NS.14 5.3607.PAX 25-x95.266o Elliallirilij The oltowin, is re•uired in;, ,•awn ti31RL:1, ,,,4, , a••Ucation will not be acce•ted. Ftease 'rint/e_•lb/ in in or t •e. r 3E PROPERTY INFORMATION SITE ADDRESS � �`-t D 1 11. `? SUITE/UNIT# ASSESSOR'S TAX/PARCEL # -_ _ — � . _ - _ — LOT SIZE(OA/ LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)_SC 1, rr' S m,,,„,i,snpc,nur pnoci+'"gVtie wig yvipGa,y • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION IA ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit grill) PROJECT NAME(Name of Business or Owner Last Name) III PEOPLE INFORMATION PROPERTY Me PRIMARY P1•10 E OWNER I�` 9C ,1 yvaS _ (�„y-��:2- MAII,LNO ADDRESS C11Y, 'ATE,ZIP -*- A 63 CONTRACTOR cOMPAA`I YNAME M APPLICANT NAME OFFICE PHONE' �( N(S AnE')121: As ��� CITY y'TAT ZIP ( ) �� " l Q CELL1 UNE • .' lei. i.� 181172- ( ) °"4j CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ' NIRATION DATE FAX NUMBER a-c�-t)Q--I r1 Ce q-mac? 1Z/ l / cam► 1 _ 0 CONTRACTOE'S REGISTRATION NUMBER(copy of card required with each applic txou) EXPIRATION DATE 2, h u 1. � & 1- q 5'\ / / APPLICANT COMPANY NAM! _ APPLICANT NAME. OFFICE Py6Nh' MAILING ADGP.ESSvl r� CITY,STATE,zip CELL PHONE ... "" KELATIC)NS;HIPTo YRO:)EGC FAX NU viItEP D Architect a Tenant ❑Agent 0 Other(Describe) ( ) _ CONTACT RAMI? PRIMARY 1'IIONR _ E-MAIL AI7DREnS LENDER Per RCW 19.27.096: ,yonder information is NAM1L required ifprojcct•value exceeds$5,000 MAILING ADDRESS CITY,STATE,211' • DETAILED BUILDING INFORMATION EXISTING USE PROPOSED USE EXISTING ASSESSED/APPRAISED VALUE $ _ VALUE OF PROPOSED WORK $ SPRINKLEIZED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO WATER SERVICE PROVIDER ❑ LAKEHAVEN L IIIGIILINE 0 TACOMA 0 PRIVATE(WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN to HIGRLINE ❑ PRIVATE (SEPTIC) 1111 -15-'05 10:09 FROM-Chubb Security 2065215340 T-470 P03/05 U-236 PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ, FT. SQ.FT. BASEMENT FIRST SECOND THIRDM .� FOURTH ADDITIONAL FLOORS(DESCRIBE) DECK(COVERED?) GARAGE 0 CARPORT 0 NUMBER OF FLOORS BXIBTINO reO,osmn TOTAL. TOTAL POSTING Ear TOTAL PROrocw sp TO AL or "NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type of fixture to be iri:,talled Or relocated as part of this prOject. Do nor include existing fixtures to remain. MECHANICAL Value of Mechanical Work $ AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS BBQS FANS HOObS Cc)n.•rcx.1 WOODSTOVES TOILERS PJR)WI.ACE INSERTS RANGES MISC(Describe) COMPRESSORS FURNACES GAs WATER HEATERS DUCTS GAS PIPE OUTLETS PLUMBING BATHTUBS(orAa,/RhoworCombo) SHOWERS WATER CLOSETS rrow.0 MISC(Describe) DISHWASHERS SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST WASHING MACHINES URINALS HOSE BIBBS LAVS cii,d.firoom ,, ,) 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. gaal'') '" NAME/TITLE PAr— DATE `+ JS (tiiCnowee) O --- RELATIONSHIP TO PROJECT 0 Owner 0 Agent contractor 0 Architect 0 Other FOR OFFICE USE ONLY, • . a NEW n ADDITION .,ALTERATION a REPAIR r_•TENANT IMPROVEMENT ~BUILDING SHELL ONLY? C YES u NO ' BASIC PLAN? u YES u NO ~ ZONING DESIGNATION CHANGE OF USE? n YES a NO NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU? u YES U NO PLATTED LOT? C.YES o NO DEMO PERMIT REQUIRED? OYES c, NO 13 Actin/1100-January 7,2005 Pagc 2 of 4 k\I ianduuts\Permit Application r''""^;2-15-'05 10:10 FROM-Chubb Security 2065215340 T-470 PO4/05 U-236 ELECTRICAL PERMIT INFORMATION RESIDENTIAL COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIAL IND STRIAE SE VICE ❑ Single Family SquarePeet Service or Feeder EachAdd'n (First 1300113-$104.50; Each add'n 500 ft^--$33.50) ❑ 0 to 100 amp $1 13,50 $69.50 Q Detached outbuilding or garage 0 101-200 amp 141.00 89.00 (Inspected with service) $44.00 0 201-400 amp 264.50 104.00 ❑ Detached outbuilding or garage 0 401-600 amp 308.00 123.50 (Inspected separately) $69,50 0 601-800 amp 398.50 168.50 ❑ 801 - 1000 amp 486.50 203.50 NEW MULTI-FAmg.y(three units or more) Q Over 1000 amp 530.50 283.00 Service Feeder O Up to 200 amp $113.50 $33.50 0 Over 600 volts surcharge $89,00 ❑ 201 -400 amp 141.00 69.50 O Mast or meter repair $96.00 0 401 - 600 amp 193.00 96,00 0 601 800 amp 247.00 132,00 QL§RED COMIVIFICIAL/INDVsIt7AL ❑ Over 800 amp 353.50 264.50 Service or Feeders O 0 to 200 amp $113.50 A&LTERED SINQj E/MULTI FAMILY 0 201 -600 amp 264.50 ❑ 601 - 1000 amp 398.50 Service or Feeder ❑ over 1000 amp 443.50 U 0 to 200 amp $87.00 Q 201 - 600 amp 141.00 ❑ # of circuits to be added/altered Q over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea) ❑ # of circuits to be added/altered S.Q1tEZVIERCIAL/INDT SERIAL PLAN VIES► (1.4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%Of permit Pee ❑ Service- 1,000 amps or greater © Mast.or meter repair $52.00 0 Medical/Educational/Institutional Facility MOBILE HOMES ❑ Service or feeder only $69.50 O Service and feeder $113.50 TEMPORARY SERVICE MOBILE HOME/RV PARK Residential/Mutti-,Family $61.00 ❑ # of service or feeders (First service/feeder-$59,50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity ❑ 0- 100 amps $60.50 U 101-200 amps 89.00 O 201 V-400 amps 104,50 U 401-600 snips 141,00 U over 600 amps 152.50 MISCELLANEOUS SERVICE/EQUIPMENT ❑ # of Thermostats ❑ #of Signs (First-$52.00;add'n-$16.00/ea) (First sign-$52.00:add'n sign $24.50/ca) Low Voltage ❑ Swimming pool/hot tub $$7.P0 Square Feet to be served cl by systcm(s - � or (Includes additional circuit,it required) 0 Fire Alarm system iI / 0 Yard Pole meter loops $104.50 Security Alarm System (O ❑ Additional Plan Review $104.50/hour 10 wire Cabling (for modified submittals) D Data Cabling 0 O Automation Fee on all Permits . $5.00 (Per Systems)1•.3500 ft'$61.00• Each add 2500 ti..6.00 rWAC:29G-4ri.biu(.^,)p,//l n.,v) Buil6tin fI 100-January 7. 2005 Page 3 Of 4 klHandouts\Permit Application