04-104385 Federal Way �ECEIVE q � 0 � 3 B S
COMMUNITY DEVELOPMENT SERVICES A 'ERMIT SF MF CO ME �•L DE EN FP
3332FEDERAENUE.SOUFAX
98063 BO971 971E 2 A DOP L I C A T I O N
FEDERAL WAY,WA 98063-9718 [J'tfJl ro
253-835-2607•FAX 253-835-2609 OCT1
uu.wat goffederalwa y.tom
The following is required Y 411 s ; k -fiAin
•mplete ap.lication will not be accepted. Please print legibly(in ink)or type.
PROPERTY INFORMATION
SITE ADDRESS 010\5- Sof/ 33e— a i"<
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates, Lot 1)
(Attach separate page Jar lengthy legal de5-mP
non
.•_ . ._ - -. , i.. -.. .
• ..PROJECT INFORMATION,• • .-
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING ❑ FIRE PREVENTIQN SY TEM
PROJECT DESCRIPTION (Provide detailed description of work included on this .ermit •
•04 bp',t1 - C ,ecu �IBRI E "
as I ',, � i r '� ,/. IIEF
PROJECT NAME(Name of Business or Owner Last Name) flair
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONES
t .
OWNER AP/J 13- 7` �d,3'3 8Q''/ 37,sr
MAILING ADDRESS
�• CITY,STATE,ZIP
alas'cSk/ .33f2 ,X. F-,D 'rieL- 4 ,x/ wit- 9rpo13
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMB ER
/
B L
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMB ER
0 Architect o Tenant ❑Agent 0 Other(Describe)
( )
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 BIIIILDING INFORMATION -
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES a NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
- . . • ELECTRICAL PERMIT INFORMATION
RESIDENTIAL `'411111111COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single 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 a 201 -400 amp 220.50 87.00
a 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) ❑ 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
a 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
O 601 -800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY ❑ 0 to 200 amp $ 94.50
a 201 -600 amp 220.50
Service or Feeder ❑ 601 - 1000 amp 332.00
a 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
a 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)
❑ 1- #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 ❑ Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
O Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
1 ❑ Service or feeder only $58.00 TEMPORARY SERVICE
❑ Service and feeder $94.50
' Commercial Residential
MOBILE HOME/RV PARK 0 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
a #of Thermostats ❑ # 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 a Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
O Data Cabling
0
(Per System(s) 1•.2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) •Per WAC 2964G-91O(5)(LO&1.)
Bulletin#100-March 30,2004 Page 3 of 4 k\llandouts-Rcviscd\Pcnnit Application