09-1042800
Federal RECEIVED PERMIT
COMMUNITY DEVELOPMENT SERVICES 1 "PLICATION
253 607• FAX 253- 09
www. 2
www. cU vo(federalwau.co u.mm
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SF MF CO ME EL PL DE ENVnP
PROPERTY
SITE ADDRESS CDS
A\-
SUITE/UNIT#
ZONING
ASSESSOR'S TAX/PARCEL # -
PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name)
u u rL WS Le
❑ BUILDING ❑ 6UMIRIAG ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING PREVENTION
eFIRE
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PEOPLE
NAME
PRIMARY PHONE
PROPERTY OWNER
` A
( -
MAIIno AD REBS, CFIY. STATE, zo E -MAD.
3 6 ----
Zd,
OWNER IS ALSO:
❑ CONTRACTOR APPLICANT PROJECT CONTACT
NAME
PRIMARY PHONE
( S.� ),W,;l - 20D0
MAILING ADDRESS, CITY, STATE, ZIP
FAX
CONTRACTOR
44)L
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
/� A
' " e
( -
APPLICANT
MAII.IIHG ADDRE8 3. CITY, STATE ZIP
FAX
p �
id)- OA 3 i
( -
PROJECT CONTACT
NAME
PRIMARY PHONE
(The individual to receive and
all,(
-
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
( _
ALTERNATE CONTACT NAME:
PRIMARY PHONE
E-MAIL
1
PROJECT FINANCING
NAME
_
OWNER-FINAN
Required for projects with
-
MAILING ADDRESS,CITY, STATE,_ ZJP _
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 art of this application.
U
SIGNATURE: �/ �( DATE I QO 1
PRINT NAME:
Bulletin #100 - 4/21/2009 1
Page I of 4 k:\Ilandouts\Permit Application
hA
11
T
)PXENERAL INFORMA ION
MECHANICAL FIXTURES
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existft fixtures to remain.
AIR DLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CO ITIONER
FIREPLACE INSERTS HOODS (com or,r )
BOILERS
FURNACES HOT WATER TANKS (cas)
COMPRESS S
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
)PXENERAL INFORMA ION
PLUMBING
FIXTURES
Indicate number of each
e of fixture to be installed or relocated as part of this project. D not include existing fixtures to remain.
BATHTUBS (or Tub/shower comb LAVS (Hand sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM REAKERS
DRINKING FOUNTAINS
SINKS auteh—/Umtty)
WATE EATERS (Ek,rtric)
HOSE BIBBS
SUMPS
WAS NG MACHINES TOTAL FIXTURES
)PXENERAL INFORMA ION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYO
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
❑ Y es ❑ No
Li Yes ❑ No
RES NTIAL
AREA DESCRIPTION (in square feet) EXISTING P SED TOTAL
FOR OFFICE USE
................... .... _...._...... ..----................ ....,.............,............................. .................. .................................. ,......
.
BASEMENT
............................_................................... _.. . ................... _...... ..... _... _... .................................................. . .................
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area TotalsaT��
**ATEW HOMES ONLY"
ESTIMATED SELLING PRICE
PROPOS®
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
X. Square Feet
Group(s)
Construction
TypOccupancy
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
OMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPT ON
Area
in Square Feet
Occupancy Group(s)
Construction
Tvva
# of
Stories
Additional Information
TOTAL BUILDING '.
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - 4/21/2009
Page 2 of 4
k:\Handouts\Permit Application
'I
' ELECTRICAL
0
RESIDENTIAL
COMMERCIAL
NEW SINGLE FAMILY RESIDENCE
NEW COMMERCIAL
Total Square Feet
1st Service/Feeder Additional Feeders
(including attached garage):
0 - 100 amp x $131.50 x $ 80.00
FEES: First 1300 ftz - $121.00;
101 - 200 amp x $163.00 x $103.00
Each additional 500 ftz - $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)
1st 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
1s1 Service/Feeder Additional Feeders
1st Service/Feeder Additional Feeders
0 - 200 amp x $131.50 x $103.00
0 - 200 amp x $100.50 x $ 39.00
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
$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
1st Service/Feeder Additional Feeders
❑ Security Alarm System
❑ Voice/Data Cabling
0 - 60 amp x $ 71.00 x $ 32.00
❑ Other
61 - 100 amp x $ 80.00 x $ 39.00
Area to be served by system: �j ®�
101 - 200 amp x $103.50 x $ 51.00
1s, 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