03-105405 - City of Federal Way Electrical Permit #:03 - 105405 - 00 - EL
Commwiity 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: CONOCO PHILLIPS 76 GAS STATION
Project Address: 33520 21ST`SWp v i Parcel Number: 132103 9098
Project Description: Install(1)tank monitor circuit,disconnet&reconnect(6)dispensers,install intercom
Owner Applicant Contractor
CONOCO PHILLIPS TRI-M ELECTRIC LLC TRI-M ELECTRIC LLC
CONOCO PHILLIPS 7515 201ST ST SW 7515 201ST ST SW
33520 21ST AVE SW LYNNWOOD WA LYNNWOOD WA
FEDERAL WAY WA (425)773-4677
Electrical Fixtures
. I304r tt(061 .. s I M t1M *Mr Wescriptio tiCAQr 6
Circuits- Commercial 1
PERMIT EXPIRES June 9,2004.
Permit issued on December 12,2003
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: �- � Date:/�►p� /(Z.-//Z7/0
/z_ ice— 0 (1119rw� CS
CONSTRUCTION PERMIT APPLICA ON
CITY OF �.� RECEIVED APPLICATION NUMBER: n - je15-`L D 51490
Federal Way APPLICATION NUMBER: -DEC 1 2 2003 'APPLICATION NUMBER: - -
"TheQb111pr4/j ����i�E��r.� ice information-Please print(in ink)or type**
Please note: Electrical,Fire PreyL�htlUrlPfsfecirps and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 22)5Z0 . Lr )r�"V ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- ■ PROSECT INFORMATION -
TYPE OF PROJECT(This application): o BUILDING o PLUMBING 0 MECHANICAL o DEMOLITION
'LECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): L - 1 ' 1 LA ,.,A
L i c4- tS .G(&)5�g7
PROJECT NAME: C�frok)OG0 -pt-4I t�t�1 �� /c C i��0
_ _ • • PEOPLE INFORMATION
PROPERTY OWNER: ' NAME: DAYTIME PHONE
(hoc-o CO-4(L-4-,,' Lig (y2 ) -775 - 477
MAILING ADDRESS(STREET ADDRESS; ,STATE,ZIP):
r ,
-z2-3zz? 2-c4`r. iko t- `- y adv.
CONTRACTOR: NAME: '-1 ?�-1N(-moi , - RIC_ DAYTIME PHONE: /
(eta) A3 - t�147
MAILING A RESS(STREET ADDRESS;CITY. ATE.ZIP)E 75-1 7.214 1 EVENING PHONE:
lAal�_�a�.Grf�i A fr ( `z(') 7; - a Z4k,
i
CITY OF FEDERAL WAY BUSINESS LICENSE NU BER: FAX NUMBER:
- (4/Z5-) -778 - (°r-j O
CONTRACTOR'S REGISTRATION NUMBER: y� EXPIRATION DATE:(ropy of card required) T M t/ `c 9 I e 3 ja / e75'- / 64
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE.ZIP): EVENING PHONE:
( )
, I RELATIONSHIP TO PROJECT: j FAX NUMBER:
o ARCHITECT 0 TENANT ❑ OTHER( DESCRIBE): I ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT .-{(60-NTRACTOR
I DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
1. PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ -
SPRINKLERED BUILDING? 0 YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN O HIGHLINE ❑ TACOMA 0 PRIVATE(WELL) '
SEWER SERVICE PROVIDER: 0 LAKEHAVEN o 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
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
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 o 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 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 daim(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 daim a ses out of the reliance of the city,induding Its officers and employees,upon the accuracy
of the information supplied to the ci. as- part of this application.NAME/TITLE: Ii O0DATE: l Z !Z ('O27
o PROPERTY OWNER ❑APP •NT TRACTOR
...FOR OFFICE.USE.ONLY
rireW IMIC DITION ,D ALTERATION V ❑rREPAIR . :TENANT>IMPROVEMENT
CENSUS`CODE a*a ?-•. r .aLOT.SIZE: -� -" °:
:ZONING DESIGNATION p 3x - 'BUILDING SHELL=ONLY? o YES -❑ NO
(COMP PLAN DESIGNATION :. * ,, BASIC PLAN? y❑YES . C].NO i�` - `
SECTIONS .. TOWNSHIP_ ? :RANGE P f -NEW ADDRESS REQUIRED?!=it; 'W o YES ❑ NO
PLATTED-LOT? a YES k,o'NO ; =CHANGE OF USE?; . n YES 'fl NO•
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cftvofffederalway.com
•
■ ELECTRICAL
•
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $57.00 _11 of Thermostats(First-$43.00;add'n-$13.00ca)
(First 1300 ft2-$85.50;Each add'n 500 ft'-$27.50) _Service and feeder $93.00 _ft of Low voltage fire or burglar alarms
Square Feet First 2500 ft1-$50.00;Each add'n 2500 ft`-$13-00
_Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _ft of service or feeders 'Per WAC 296-46-910(5)(b)(i&ii)
_Each outbuilding or garage 557.00 (First service/feeder-557.00;Add'n service/ _ft of Signs(First sign-543.00;add'n sign
(Inspected separately) feeder-537 each) $20.00 each)
_Swimming pool,hot tub,spa $85.50
I _Yard Pole meter loops 557.01)
II
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units ar more) Altered Service or Feeders l
Service Feeder Amps Service or Add'n 0 to 200 5 93.2)0
_Up to 200 amp S 93.00 $ 27.50 Feeder _201 -600 216.50
-201 -400 amp 115.50 57.00 -0 to 100 1 93-00 1 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 -J-_I f of circuits
Over 800 amp 289.50 216.50 _401 -600 252.50 101.00 (1-5 circuits-572.50;Add'n circuits,$6 ear
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/Commerciai/lndustrial
0 to 200 amp $ 71.50 _Over 600 volts surcharge 72.50 -U-100 5 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
rt 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+$72.50.Add'(plan review for other submissions is$85.50/hr.
i FIXTURE DESCRIPTION(A) FIXTURE.FEE FROM TABLE B(B) ' NUMBER OF UNITS(C) TOTAL(D)
i I {
II
f ;
-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)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100-December 23, 2002 (
i