07-104210 RECEJ D •
A.
cm or JUL 3 0 2007 12 - I _6 44 2 ( -0
Federal Way PERMIT SF MF CO ME EL PL DE EN P
COMMUNITY DEVELOPMENT SERV(O�$Y 0 F FED E
3332F FEDERAL
WAY.
AJN•639O7*��1$ e`VFLI CATION T° f
FEDERAL WAY,WA 980&9.8718 BUILDING
253.835-2607•FAX 263-835-2609 '—
i W.CiGc0 ck'ral au.Coln
The following is required irijbrmatlon-an incomplete application will not be accepted. Please print legibly(in ink)or type.
^� [ I PROPERTY INFORMATION
SITE ADDRESS ( 9 13- P '.C `I
�7 L H•StvwOI 7 `1+L\ SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 3 3 3.,?-- 0 4 - ci Q G 0 LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot I) LA eci+n.t O v j.+A a
ranch separate page for lengthy lop.?d000'4.onI
MI PROJECT INFORMATION
TYYi:OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING X1 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onig)
' v 1,4. 4 n Lw F :,r it. •.1 Ar WI ryas S c. rel,:Ate). )(wn s_
PROJECT NAME(Name of,Buslness or Owner J.ast Name) L A c'''.4 11
® a PEOPLE INFORMATION
OWNER
PROPERTY NAME /® h n I ��— 4- j 4RIMARYcHONE -
MAILING',ADDDRESS yK,-Lv'JlC_J_.y CRY.STA ZIP /`'_'C/ E-MAIL ADDRESS
CONTRACTOR COMPANY NAME t' 1j APPLICANT NNA�ME ` OFFICE PHONE
j►m r.L�ti �t.Y0.� it E1l4�t.e. , �.STA13 -' (360)3TE,ZIP CELL .9H -4464
Ili
14,�
MAILING ADDRESS M{C 4 WA 41qan (LIU) 5 O�-R'4 7'1
131 o,'a Se•f'. ILL.
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
2.o - O"} • 10304 • on 13L 1713iioa- (Ito ) 7iii Si 1'►
CONTRACTOR'S REGISTRATION NUMBER EXPIRA'I N DA E-MAIL ADDRESS
COPY of cord �
with .ppeo.tlon b PLM E=5E151 f.3 cbli%J di _seal .r3&wc.1►a Yo.ib.0 r.
APPLICANT COMP �- APPLICANT NAME OFFICE PHONE( ) -
MAIUN ADD CITY,STATE.ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect ❑Tenant o Agent ❑Other ( ) -
PROJECT NAME ,� PRIMARY PHONE E-MAIL ADDRESS
CONTACT ( Ok RT c UY/ ( )
LENDER NAME Per Am 19.27.095:
Lender injbrmatlon is required if project value exceeds$5,000
MAILING ADDRESS CITY.STATE,ZIP PHONE
( )
■ DE'T'AILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ 1_0, oc et
SPRINKLERED BUILDING? 0 YES ❑NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 IIIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN ❑HIGHLINE 0 PRIVATE(SEPTIC)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ. FT.
SEN r NT
• I
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE ❑ CARPORT 0
EXISTING PROPOSED TOTAL - TOTAL EVSTING Sr TOTAL PROPOSED Sr TOTAL SI
NUMBER OF FLOORS
1
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ 1
I !
• ■ 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$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) i
i
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commerdel)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
I
PLUMBING ,(
BATHTUBS)or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet) i
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
• i
•
SIGNATURE
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 an person, including the undersigned, and filed against the City of Federal Way,but only where such claim
arises out of the reliance o e .,0ecluding its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE - aw ,4111111■■... /w .c,•ti <-4,-, n.--,,nDATE /347,• I
(Signature) _. (Title
RELATIONSHIP TO PROJECT ❑ Owner 0 AgentContractor 0 Architect 0 Other
F16;16-FI -g,'6 Lyz , 'ift
o NEW o ADDITION o ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100-April 2,2007 . Page 2 of-4 k\Handouts\Permit Application
• •
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
U Single Family Square Feet Service or Feeder Each Add'n
(First 1300 ft2-$111.00;Each add'n 500 ft2-$35.50) ❑ 0 to 100 amp $120.50 $74.00
U Detached outbuilding or garage ❑ 101-200 amp 149.50 94.50
(Inspected with service) $47.00 ❑ 201-400 amp 280.00 111.00
❑ Detached outbuilding or garage ❑ 401-600 amp 327.00 131.00
(Inspected separately) $74.00 U 601-800 amp 423.00 179.00
U 801 - 1000 amp 516.50 216.00
NEW MULTI FAMILY(three units or more) ❑ Over 1000 amp 563.00 300.00
Service Feeder
U Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50
❑ 201 -400 amp 149.50 74.00 ❑ Mast or meter repair $102.00
❑ 401 -600 amp 205.00 102.00
L3601 -800 amp 262.00 140.50 ALTERED COMMERCIAL/INDUSTRIAL
U Over 800 amp 375.50 280.50 Service or Feeders
❑ 0 to 200 amp $120.50
ALTERED(SINGLE/MULTI FAMILY U 201 -600 amp 280.50
U 601- 1000 amp 423.00
Service or Feeder U over 1000 amp 471.00
U Oto 200 amp $92.50
❑ 201 -600 amp 149.50 ❑ #of circuits to be added/altered
U over 600 amp 225.50 (1-5 circuits-$94.50;Add'n circuits,$7.00/ca)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$74.00;Add'n circuits$7.00/ea) $94.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $55.00 ❑ Medical/Educational/Institutional Facility
MANUFACTURED HOMES
U Service or feeder only $74.00
U Service and feeder $120.50
TEMPORARY SERVICE
MOBILE HOME/RV PARR Residential/Multi-Family $65.00
❑ #of service or feeders
(First service/feeder-$74.00;each add'n-$48.00) Commercial/Industrial Service or Feeder Ampacity
❑ 0-100 amps $74.00
❑ 101-200 amps 94.50
U 201-400 amps 111.00
U 401-600 amps 149.50
U over 600 amps 162.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
(First-$55.00;add'n-$17.00/ea) (First sign-$55.00;add'n sign$26.00/ea)
Low Voltage U Swimming pool/hot tub $111.00
Square Feet to be served by system(s) LiS 00 0 (Includes additional circuit,if required)
14 Fire Alarm System U Yard Pole meter loops $74.00
O Security Alarm System U Additional Plan Review $111.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling U Automation Fee on all Permits .. $5.00
1 t 2500 62-$65.00;
Each add'n 2500 62-17.00)•Per WAC 296-46-910(51tb)tt t4 to
Bulletin#100-April 2,2007 Page 3 of 4 k\Handouts\Permit Application