09-104282r• CITY OF
Federal Way
`a 4 yM
N0� Q 2 X009
PERMIT
COMMUNITY35-260DEVELOPMENT3-8 SERVICES A PP LI CAT I O N
253-835-2607• FAX 253-835-26P -�,! of FES
wwwxiluoffederalwatixom -
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SF MF CO ME EL PL DE EN P
PROPERTY
SITE ADD
`
SUITE/
ZONING
ASSESSOR'S TAX/PARCEL#
PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name)
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ELECTRICAL ❑ENGINEERING XFIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of work to
be included this
�-.
on permit only
PEOPLE
NAME
PRIMARY PHONE
PROPERTY OWNER
X16,
MAILING ADDRESS, CITY, STATE. ZIP
E-MAIL
` 21-c.- 2216. A— 'I w 1s
CONTRACTOR APPLICANT PROJECT CONTACT
OWNER IS ALSO:
NAME
PRIMARY PHONE
r
( ) - 2 c &-c
MAILING ADDRESS, CITY, STATE, ZIP (( � l��j
FAX
CONTRACTOR_
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
1/[ J
NAME
PRDNARY PHONE
'' `� `�
Lail -26t-)t)
APPLICANT
MAILING ADDRESS, CITY, STATE. ZtP
FAX
PROJECT CONTACT
NAME
PRBKARY PHONE
(The individual to receive and
-
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
_
ALTERNATE CONTACT NAME:
PRIMARY PHONE
Eryf-MAICL
PROJECT FINANCING
NAME
R -FINANCED
Requiredfor projects with
MAILING ADDRESS, CITY, STATE, ZIP
PRIMARY PHONE
value of $5,000 or more
(RCW 19.27.095)
_
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
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, 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 pµrt of this application.
I!
SIGNATURE: DATE
0
PRINT NAME:
Bulletin #100 - 4/21/2009 1 Page 1 of 4 k:\Handouts\Permit Application
It
0
GENERAL INFORMATION
MECHANICAL FIXTURES
Value o Mechanical Work $
(A CO OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be insed or relocated part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSE HOODS (Commercial)
BOILERS
FURNACES HOT WATER TANKS (Gas(
COMPRESSORS
O ETS REFRIGERATION SYST
GAS LO,
DUCTING
G IPING WOODSTOVES
GENERAL INFORMATION
PLUMBING TIXTURES
Indicate number of each type of fixture to be installed or relocate
as part of this project. Do not include existing factures to remain.
BATHTUBS (or Tob/sbowerCombo)
LAVS(HanaSinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTE
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (x;mben/Umi
WATER HEATERS (Eirrohr(
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
Additional Information
NEW BUILDING
ADDITION
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet) /
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Area
in Square Feet
�
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
..... .... ---............................................................................_................................. .......... .................. _...................
.
BASEMENT
FIRST FLOOR (or Mobile Home)
SECONDFLOOR........................_..._...._.._....._......._..._�_._�_..__..........._......._........._.._............_........................
............................__.._..__..._..._........................................................................................_..............._.........
..................
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
...... _.._.._.._.._..._..._... _..... _.._.... _.._...__........ _.... _................................... _......................................
Area Totals eusrnvO MOPOSPD TOTAL
"`NEW HOMES ONLY""
ESTIMATED SELLING PRICE $ I # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Groups)
Construction
TypOccupancy
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REM /TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Occup up(s) Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - 4/21/2009 Page 2 of 4 k:Ulandouts\Permit Application
ELECTRICAL
RESIDENTIAL
COMMERCIAL
NEW SINGLE FAMILY RESIDENCE
NEW COMMERCIAL
Total Square Feet
151 Service/Feeder Additional Feeders
(including attached garage):
0 - 100 amp x $131.50 x $ 80.00
FEES: First 1300 ft2 - $121.00;
101- 200 amp x $163.00 x $103.00
Each additional 500 ft2 - $39.00
201- 400 amp x $305.50 x $120.50
401- 600 amp x $356.00 x $142.50
NEW MULTIFAMILY (3 units or more)
151 Service/Feeder Additional Feeders
601- 800 amp x $460.50 x $195.00
0 - 200 amp x $131.50 x $ 39.00
801 - 1000 amp x $562.50 x $235.50
201 - 400 amp x $163.00 x $ 80.00
Over 1000 amp x $613.00 x $327.00
401 - 600 amp x $223.00 x $111.00
601 - 800 amp x $285.50 x $152.50
Over 600 volts surcharge x $103.00
Over 800 amp x $408.50 x $305.50
ALTERED SINGLE or MULTI FAMILY
ALTERED COMMERCIAL
l si Service/Feeder Additional Feeders
151 Service/Feeder Additional Feeders
0 - 200 amp x $100.50 x $ 39.00
0 - 200 amp x $131.50 x $103.00
201 - 600 amp x $163.00 x $ 80.00
201 - 600 amp x $305.50 x $142.50
Over 600 amp x $245.50 x $111.00
601 - 1000 amp x $460.50 x $235.50
Over 1000 amp x $513.00 x $327.00
Added or Altered Circuits
1-4 circuits $80.00; each additional $8.00
Added or Altered Circuits
1-5 circuits $103.00: each additional $8.00
Mast or meter repair $60.50
Mast or meter repair $111.00
MANUFACTURED HOMES
PLAN REVIEW FEES
Service or feeder only x $ 80.00
0
$103.00 plus 35% of Permit Fee; Plan Review required for:
Service and feeder x $131.50
❑ New, or alteration to, service of 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
Plan review for modified submittals $120.50/hour
MISCELLANEOUS SERVICE/EQUIPMENT
LOW VOLTAGE
TEMPORARY SERVICE
Fire alarm System
I,' Service/Feeder Additional Feeders
❑ Security Alarm System
❑ Voice/Data Cabling
0 - 60 amp x $ 71.00 x $ 32.00
❑ OtherI r
61 - 100 amp x $ 80.00 x $ 39.00
Area to be served by system: • l ��
101 - 200 amp x $103.50 x $ 51.00
1-, 2,500 ft2-$71.00; each additional 2,500 ft2- $18.50
201 - 400 amp x $120.00 x $ 60.50
# of Thermostats
401 - 600 amp x $163.50 x $ 80.00
First $60.50: each additional $18.50
Over 600 amp x $183.00 x $ 92.00
# of signs
"NOTE: an automation fee of $6.00 will be charged
First $60.50; each additional $28.50
on all permits"
Yard Pole/meter loops/pedestal x $ 80.00
Portable Generator (transfer equipment) x $100.50
For fixtures or fees not listed contact the Permit Center at
Ditch cover/inspection only x $120.50
253-835-2607
Bulletin #100 - 4/21/2009 Page 3 of 4 k:\Handouts\Permit Application