05-104910 L(
City of Federal Way Electrical Permit#: 05 - 104910 - 00 - EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-3050
Project Name: DAVITA FEDERAL WAY
Project Address: 1015 S 348TH $'r Parcel Number: 202104 9140
Project Description: Installation of(6)LN Thermostats and(3)Remote sensors.
Owner Applicant Contractor
CITATION MANAGEMENT GROUP EVERGREEN REFRIGERATION EVERGREEN REFRIGERATION
5312 PACIFIC HWY S 727 S KENYON ST 727 S KENYON ST
FEDERAL WAY WA SEATTLE WA 98108 SEATTLE WA 98108
(206)763-1744
Electrical Fixtures
Description Quantity r Description Quantity Description Quantity
Thermostat 9
CONDITIONS:
This parcel is located within a Wellhead Protection Area(Capture Zone 1)and must comply with FWCC,Chapter 22,
Article XIV"Crifiical Areas" and fill out.a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES March 22,2006.
Permit issued on Septeinber 23;200S sr
I hereby certify that the above information is correct and that the construct. on the above described property and
the occupancy and the use will be in accordance wit the law r�A . gulations of the State of Washington and
the City of Federal Way. /+ J
05
Owner or agent: Date:
/ h ^��..
i ' :414011kk THIS CARD IS TO REMAIN ON-SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-104910-00-EL
Owner: CITATION MANAGEMENT GROUP
Address: 1015 S 348TH ST
FEDERAL WAY, WA 98003-7027
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Slab/Concrete Floor(4255) ❑ Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels (4045)
Approved Approved Approved
By Date By Date By Date
Rough Electrical(4225) ❑ Ceiling Cover(4020) E' Final-Electrical(4055)
A
Approved Approved Approved
By Ai Date I O `3 (0<- By Date By Vow ) Date `4S`t:'7
❑ Under-slab groundwork(4295)
Approved
By Date
TIPIA . 5
0
eig_ i_ 0
OF
Federal Wa EC I VE(a — - /
y PERMIT
COMMUN7'YDEVELOPMENT SERVICES
SF MF COM EL L DE EIV FP
33325 87,*AVENUE SOUTH•PO BOX 9718FED2 3 2005
253.835-22607•FAX 253 2609 WAY,WA 98063-9718 A P P L I C ATI( T m
iaww.dtta/federatwap.com CITY OF FEDERAL
' The ollowi • is ..• fired in ormation-an inco •fete • ••licatioi. Cpl i ie•ted. Please •rant le• •1 (in or p .
'■ PROPERTY INFORMATION
SITE ADDRESS 1'DS S c> 1 n `"4 a`�S m c f l \/kkSUITE/UNIT#
ASSESSOR'S TAX/PARCEL# C) l d LI - 9 1 y AU' LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page far lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ),ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide deta- escription of work included on this permit only)
`-v- k-a..21Z S e r►nno *cicc�.✓�ck ✓e o J'e. C)+e-
P.✓NC:),C'S i
PROJECT NAME(Name of Business or Owner Last Name) 0 a v \*G _J€.{W2_
1
a PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 0\+ock;c1- c3 v* &v1 �(n'srATE,ZIP (
MAILING ADDRESS _
-S ia. Pc►G`-{-:\'c., w,l E, -`fe-Aa t q La 4
CONTRACTOR COMPANY NAME APPLICANT NAME
OFFICE PHONE E
<��,1(')?i'( (,2419) 1p3
3 .0 y MAILING ADD S CITY,STATE, CELL PHONE
,^ S S `A,lqKlb
CITY OFEDERAL WAYSS LICENSE NUMBER
EXPIRATION DATE FAX NUMBER
:la-too_-1 d L u 1_-B L ►2 /31 /as ( ) -
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
EVe g&I C)0 C S _ _7 / 3I /oCP
APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE Xa3(p
,,e', �Q� e k-liec c.r\ (� '(o)7(c, > -1- 1414
ILING AD SS , CITY,STATE,ZIP CELL PHONE
-7X7 s . 1ei,.y _y\ `-r. Se-cxctSa ( )
-
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant ❑Agent 0 Other(Describe) ( ) -
CONTACT NAME ,/� Iy 1 , • PRIMARY PHONE
1[�' /��(J,.r,^r N1\ (c200 11 63 - l-7 423`+' E-MAIL ADDRESS
LENDER 3� 4/.. �� � 3 �`tre
f NAME
1 .� (4 t t
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? a YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER ❑LAKEHAVEN a HIGHLINE a TACOMA a PRIVATE(WELL)
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a PRIVATE(SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
LXISTIRG PROPOSED TOTAL t TO_r, `a' ,X ',':,'TOTAL PROPOSED SF _ 5 AL EF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ .
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS(commercial( WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSETS(raet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(eathroomSinks) 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 oft , eluding •fix •> employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE DATE
Signatu (Title)
RELATIONSHI TO PROJECT • Owner ❑j1Cgent ❑ Contractor ❑ Architect 0 Other
ak
r`'i/ IT n C � TION R • P "x M�r • .1 1• 0 1 T � *t
1 0 �F y. c 3 0 .` ::�� ma m 't.^" � fit w YES ® 0
g h''�' ° `" ,�'"'` YES
® / o y.I ATI•ly ,CH�iEkOF 1 a
+"g .� ,--:.�- ` "": .'fir �� '�; r'UP SEPA S s t, `' � �z- .P' S s Oma
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2.®1JIRED z ....:
Bulletin#100—January 7,2005 Page 2 of 4 k'H ndouts\Permit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 0 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601-800 amp 398.50 168.50
O 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
El Up Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
O 201 -400 amp 141.00 69.50 0 Mast or meter repair $96.00
❑ 401 600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50
O 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ 0 to 200 amp $87.00
O 201 -600 amp 141.00 0 #of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea)
0 #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Fee
❑ 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
0 Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industrial Service or Feeder Ampacity
U 0- 100 amps _ $69.50
❑ 101-200 amps 89.00
O 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
W #of Thermostats ❑ #of Signs
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
Ig Low Voltage ❑ 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 $104.50
❑ Security Mann System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling for modified submittals)
❑ Data Cabling
❑ Automation Fee on all Permits .. $5.00
(Per System(s) 1.t 2500 ft2-$61.00;
Each add'n 2500 ft2-16.00) *Per WAC 29646-970(5)(6)(&ii)
Bulletin#100-January 7,2005 Page 3 of 4 k\Ilandouts\Permit Application