06-103551 •, •
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Federal Way ,ut 1 g as PERMIT
COMMUNITY DRVELOPMENrSERVICES SF MF CO ME EL PL DE EN
33315 87w AVENUE SOUTH•PO BOX 97 ,
?53-8FEDERAL WAY,WA 607 FAX 153-835 2609 I9718 II ' PP L I C A T I O N T°
www.dtuoffedemywnu.mm /
The allowing is re.uired information-an incomplete a.plication will not be accepted. Please .hint legibly in in or type.
■"PROPERTY INFORMATION
SITE ADDRESS i(,CK-) . 3"-1 b{-h S4 e.€
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SUITE/UNIT# A t C C
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach aeparnte page for lengthy legal description,
■ PROJECT INFORMATION ::-
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING yFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
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PROJECT NAME(Name of Business or Owner Last Name) A GUrc e_ Av1 QJ'i C->w
. . PEOPLE INFORMATION.. .'. .., .
PROPERTY NAME
PRIMARY PHONE
OWNER C..-)( k.:, 'V 1)i LLL .(c., )y:_3 - i/<W
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MAILING ADD ESSCITY,STATE,ZIP
Cl 15 I 1 e. k 60t-- 5. E S-k k'xc. I i)--) ...1k-,)„,i. L-rL• -' (D 5_
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
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MAILING ADDRESS CITY,STATE,ZIP 1 CELL PHONE
o4- /34+V.4.-- P/'u,e -.. 5 c--.a it/t-i k),A- l'S l`t`( ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
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CONTRACTORS REGISTRATION NUMBER(copy of card required with each applieation( EXPIRATION DATE
r .Is c_ \-_ 1 4- J `( ) > h L k 1 / <. /a)
APPLICANT COMPANY NAME_ ` APPLICANT(N E OFFICE PHONE
1!h`c(cL
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MAILING ADDRESS I CITY,STATE,ZIPCELL PHONE
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RTIONSHIPT` .—O CT . Lt Se..- 1,_,V)),. y81' ct ( ) -
FAX NUMBER
0 Architect ❑ Tenant 0 Agent o Other(Describe) (.9-06. ) -) 6 - ?i6 U
CONTACT NAME , PRIMARY PHONE E-MAIL ADDRESS
r).,`' S ,k, �� � J x )6'e - 15e0
LENDERi:i':':*44* , F 0L�§'e' ��y, 410,, NAME
MAILING ADDRESS CITY,STATE,ZIP I PHONE
rc11;:a ittk j �mS�'¢�s{.��.�r uft seF"ty ,� . a°+y rf•`� M1 ..-
.>� x. t� •� DETAILED BUILDING INFORMATION : I s,+,x`� _-40:5gA ,:' , °,r':^` ` . .: 5:.
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ vZ.0C-'6• ., C�(•---'
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
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411111
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PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPED TOTAL
SQ.FT. SQ.OSFT. SQ. FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE 0 CARPORT 0
-13
"33"4° "°"8" rare Fit} scra i;f 7 ° r t"r a( i�
NUMBER OF FLOORS
�,....,. ,..:t ...,+„�. i .,3:Lo .�.`�.,,�,..,-.. `,.a., is r..,.•.wr: {_.� .,...::._::`:
"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(commerclol) 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(-redo
(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroomstnlce) VACUUM BREAKERS ELECTRIC WATER HEATERS
. :.... .. .DISCLAIMER/SIGNATURE BLOCK` • __. ..
I certify under penalty of perjury that the irfformation 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{n the investigation and defense of
such claim), which may be made by any person,including the undersigned, and flied against the City of Federal Way,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 part of
this application.
DATE )
NAME/TITLE ' l✓
(Sigrf re) (Title)
RELATIONSHIP TO PROJE D Owner 0 Agent 0 Contractor 0 Architect ❑ Other
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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 ft2-$107.50;Each add'n 500 ft2-$34.50) ❑ 0 to 100 amp $117.00 $71.50
❑ Detached outbuilding or garage ❑ 101.-200 amp 145.00 91.50
(Inspected with service) $45.50 ❑ 201-400 amp 272.00 107.50
❑ Detached outbuilding or garage ❑ 401-600 amp 317.00 127.00
(Inspected separately) $71.50 ❑ 601-800 amp 410.00 173.50
O 801 - 1000 amp 500.50 209.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 546.00 291.00
Service Feeder
❑ Up to 200 amp $117.00 $34.50 ❑ Over 600 volts surcharge $91.50
❑ 201 -400 amp 145.00 71.50 ❑ Mast or meter repair $99.00
❑ 401 -600 amp 198.50 99.00 ALTERED COMMERCIAL/INDUSTRIAL
0 601 -800 amp 254.00 136.00
❑ Over 800 amp 364.00 272.00 Service or Feeders
❑ 0 to 200 amp $117.00
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 272.00
❑ 601 - 1000 amp 410.00
Service or Feeder ❑ over 1000 amp 456.50
❑ Oto 200 amp $89.50
❑ 201 -600 amp 145.00 ❑ #of circuits to be added/altered
❑ over 600 amp 218.50 (1-5 circuits-$91.50;Add'n circuits,$7.00/ea)
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o #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$71.50;Add'n circuits$7.00/ea) $91.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
❑ Mast or meter repair $53.50 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $71.50
❑ Service and feeder $117.00
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residentia
i/Multi-Family $63.00
❑ #of service or feeders
(First service/feeder-$71.50;each add'n-$46.50) Commercial/Industrial Service or Feeder Ampacity
❑ 0- 100 amps $71.50
❑ 101-200 amps 91.50
❑ 201-400 amps 107.50
❑ 401-600 amps 145.00
O over 600 amps 157.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ # of Signs
(First-$53.50;add'n-$16.50/ea) 1 1 ( .Lj (First sign-$53.50; add'n sign$25.00/ea)
1,Low Voltage ❑ Swimming pool/hot tub $107.50
uare Feet to be served by system(s) g'i -
(Includes additional circuit,if required)
ire Alarm System ❑ Yard Pole meter loops $71.50
Security Alarm System ❑ Additional Plan Review $107.50/hour
o Voice Cabling (for modified submittals)
❑ Data Cabling
0 Automation Fee on all Permits .. $5.00
0
(Per System(s) 1.'2500 ft2-$63.00;
Each add'n 2500 ft2-16.50) "Per WAC 296-46-910(5)(b)'i&ii)