04-104143 •
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CITY OF �a '�.r i b q l S
Federal way RE PERMIT __00
COMMUNITY DEVELOPMEIVT SERVICES
SF MF CO ME PL DE EN FP
33530 FIRST WAY SOUTH•PO BOX 9718 / /
FEDERAL WA FAX 253 6663-9718 1-4 129 0 c1 1120 A L TD
wwm cituofederaiwau.como f FEpERA►p.WAY
The ollowin• is r9.u,,t-;; i t; '• - I.MAL an incomplete application will not be accepted. Please print legibly(in ink)or type.
11 ,,__ nn PROPERTY INFORMATION
SITE ADDRESS
OM & ,L \ QAa6� 1'i?��� v` SUITE/UNIT#
ASSESSOR'S TAX/PARCEL # - LOT SIZE (sf)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal desrnp ion)
PROJECT INFORMATION
TYPE OF PERMIT o BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION XELECTRICAL o ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Providedetailed description of work included on this permit only)
LtS� w� e, rc>t4. _ se„ 0,-1 l-A sGo,eG- 0- ,r-- ,
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PROJECT NAME(Name of Business or Owner Last Name) i( �04.I,o'(ik
PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 5Az-P•J'!icw t---6— 5.-w-c k ( ) -
MAILING ADDRESS CITY,STATE,ZIP
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Encrar-1 (ZSo ) 746 -CA—O0
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1 A- -A- D.Vt- NL N„2,,>/, w ctfy (.lot, ) z-SS -`y?61
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - / / (253 )243 C'S-0.--3
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
E N E . P x- it-- a s 1 P Z to / V L los
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 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 ercceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? o YES 0 NO
WATER SERVICE PROVIDER o LAKEHAVEN o HIGHLINE ❑ TACOMA o PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
P t• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING SQ. FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**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(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sulks) 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'f Federal Way as to any claim (including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim), which) ay be made b n erson, includi g the undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the r I nce of the ty ' uding its offic s and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME TITLE i n� i"7sS' Sct,Is DATE C.
NAME/
(Signa re) (Title)
RELATIONSHIP TO PROJECT ❑ Owner 0 Agent Contractor 0 Architect 0 Other
FOR OFFICE USE ONLY
u NEW u ADDITION u ALTERATION EJ REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? ❑YES a NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? ;YES o NO UP/SEPA/SU? a YES a NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES ❑ NO
Bulletin#100—March 30,2004 Page 2 of 4 k\Handouts—Revised\Permit Application
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ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ft,-$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 ❑ 201-400 amp 220.50 87.00
❑ 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
❑ 401 -600 amp 161.00 80.00 ❑ Mast or meter repair $80.00
❑ 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
201 -600 amp 220.50
Service or Feeder 601 - 1000 amp 332.00
❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50
❑ 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)
❑ #ocircuits be added/alteredCOMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;
$6.0;Add'n circuits$6.00/ea)
$74.00 plus 35%of Permit Fee
❑ Mast or meter repair $43.50 U Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
❑ Service or feeder only $58.00 TEMPORARY SERVICE
❑ Service and feeder $94.50
Commercial Residential
MOBILE HOME/RV PARK ❑ 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
❑ #of Thermostats ❑ #of Signs
(First-$43.50;add'n-$13.50/ea) (First sign-$43.50;add'n sign$20.50/ea)
❑ Low Voltage ❑ Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $58.00
O Security Alarm System ❑ Additional Plan Review $87.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
0
(Per System(s) 1st 2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) 'Per WAC 296-46-910(5)(b)(i&ii)
Bulletin#100-March 30,2004 Page 3 of 4 k\Handouts-Revised\Permit Application