03-101462 City of Federal Way
Community Development Services Electrical Permit #:03 - 101462 - 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: DASH POINT CHIROPRACTIC
Project Address: 1612 SW DASH POINT a,1 Parcel Number: 122103 9074
Project Description: New intrusion alarm
Owner Applicant Contractor
AUDREY/SYDNEY IRMAS CHARITABLE F( BRINKS HOME SECURITY INC BRINKS HOME SECURITY INC
20206 72ND AVE S 19115 WEST VALLEY HWY SUITE H-106 19115 WEST VALLEY HWY SUITE H-106
KENT WA 98032-2322 KENT WA 98032 KENT WA 98032
(425)251-9727
Electrical Fixtures
34; /:,--desorlptian'v2 Quant4
Low Voltage Burglar Alarm -Comm 1500
PERMIT EXPIRES October 12,2003.
Permit issued on April 15,2003
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 oragent:<<y PL1CaTo t° Date: 11/S/03
COMMUNITY RECEVP D BY FPAoT
411111%, CZ-0
INSTRUCTION PERMIT APPLICATION
CITY OF APR 15 2003 APPLICATION NUMBER: 03 - 101 b 6.-0.
Federal Way APPLICATION NUMBER: -
'""` APPLICATION NUMBER: -**The following is required information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
SITE ADDRESS: 1612 SW DASH POINT RD ASSESSOR'S TAX/PARCEL#:
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
• PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING ❑ MECHANICAL o DEMOLITION
XX ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): INTRUSION ALARM
PROJECT NAME:
• PROJECT INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
DASH POINT CHIROPRACTIC ( 253 ) 835-5678
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
1612 SW DASH POINT RD,FEDERAL WAY,WA 98023
CONTRACTOR: NAME: DAYTIME PHONE:
BRINK'S HOME SECURITY ( 425 ) 251 - 9727
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
19115 W VALLEY HWY#H106, KENT,WA 98032 ( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
19-98-105789-00-BL ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) BRINK HS L48 LE
APPLICANT: NAME: DAYTIME PHONE:
( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT o CONTRACTOR
• PROJECT INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE ❑ 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
AIR HANDLING EVAPORATIVE GAS LOG(S) REFRIG.SYSTEM(S)
UNIT'S) COOLER(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 VACUUM BREAKER(S) o ELECTRIC o GAS
SYS.
DRINKING SHOWER'S) WASH MACHINE
FOUNTAIN(S) 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 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.
NAME/TITLE: gluea ���-7 DATE:
o PROPERTY OWNER o APPLICANT CONTRACTOR
FOR OFFICE USE ONLY:
o NEW o ADDITION o ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? o YES o NO
COMP PLAN DESIGNATION BASIC PLAN? o YES o NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? o YES o NO
PLATTED LOT? ❑ YES 0 NO CHANGE OF USE? o YES o NO
' 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)
• ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
Single Family _Service or feeder only $57.00 _#of Thermostats(First-$43.00:add'n-$13.00ea)
(First 1300 ft2-$85.50;Each add'n 500 112 427.50) _Service and feeder $93.00 #of Low voltage tire or burglar alarms
Square Feet: First 2500 ft2-$50.00;Each add'n 2500 ft2-$13.00
_Each outbuilding or garage $35.50 MOBILE HOME/RV PARK Square Feet: 1500
(Inspected with service) _#of service or feeders *Per WAC 296-46-910(5)(b)(i&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
Yard Pole meter loops $57.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200 $ 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 $ 93.00 $ 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 85.50C-1-5
#of circuits
_Over 800 amp 289.50 )16.50 _401 -600 252.50 101.00 (I-5 circuits-$72.50;Add=n circuits.$6 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
_over 600 amp 174.00 _201 -400 85.50
_Mast or meter repair 43.00 _401 -600 1 15.50
#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=l plan review for other submissions is$85.50/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(12):
Total Column(D)
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
le
Estimated Permit Fee:(16)
Bond Amount: (17)
• OTHER FEES
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23)