05-103837 ' .� c�•S 1 L'�c�iv -
GTN OF ` L � � �
, Federal Way � � `�
COAfMUM7YDBVEfAPA(ENTSERVlCES ERMIT AUG d 2 F F CO ME EL PL DE EN FP
33325 8TM AVENUE SOUTN.��X 9�,8 A p p L I C AT I 4� �
� fEDERALWAY,WA 980G7-9718 I F FEDERA �lrAX /] / / O
253-835-2607•F,,x sss-e3s-s6ov - LD I N G D E T ���
www.rityoJf`edera(way.mm /
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The ollowt is re uired in ormaHon-an{nco lete lication wi11 not be acce ted. Piease rint le ibi in in or
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SITE ADDRE.SS 1 ( (/ V SUITE/i7DTIT�F
� ASSESSOR'S TAX/PARCEL# _ _ _ _ _ _- _ _ _ _ LOT SIZE(s,�
� LEGAL DFSCRIPTION(e.g.Acm.e E es J
A pa8� d 'h
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TYPE OF PERMIT �BUILDING ❑ PLUII�ING ❑ MECHANICAL
� ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DFSCRIPTION(Provide detailed description of work included on this permit onlul f
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PROJECT NAME(Name of Business or Owner Last Name) �Z � � �C-� �
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� PROPERTY NAME
PRIMARY PHONE
f owxER G�.CSLe,�.i� C:o+� T(1.t�c.;T i u= (2�� ) �23 - 6G5 6
jMA[UNG ADDRESS �yr��}.+ C(TY,STpTE,Z[P
; ti LS Pon►��,,�� �� -tIF i 2� Sz-r+Jt'T'tx. ..,�3 v.}-5 ri 9�i o�i
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CONTRACTOR �MPANY NAME APPLICANT NAME OFFICE PHONE
f GrLCSC.w�T C�oN S"R..�..c.Twn9 'TEO GNESLc1'Jo� �'=on ) 32; ' G6S-6
MAIUNCi ADDRESS ��„�,� C[TY,STATE,ZIP CELL PHONE
� �Z.S � ..J 1..� s #�lZ� �"rlL�- i.JN} 9 iv�l ��o � 77+� ' �7�lZp
G'fY OF FEDERAL WAY HUSINESS UCENSE NUMBER EXPIRATION DATE FAX NUMBER �•T6�
�` � v - 0 S- t � � �i � $-B L 1'Z �i� �o � (2�6 131.3 -�-6
I CONTRACTORS REGISTRATION NUMBER(oop�of card reqnlred with each appHcation) EXPIRATION DATE
� G g � S c e � � s � �� s �2y �o�
, — — — — —
i APPLICANT COMPANY NAME APPLICANT NAME
OFFICE PHONE
` G+�-S � C.v^�S� t�C4.SC.tM"� C-(JniST �2�� I 3 Z�S ' 6 6S E>
MA[LING ADDRESS N�;(,,� CITY,STATE,ZIP ' CELL PHONE
�iLS Pc�,u� ' v� S � #i2 S���TTI.�. �I !o �Z�''� ) "��� -��`�L�J
RELATIONSHIP TO PROJECT FAX NUMBER
o Architect ❑ Tenant ❑Agent o Other(DescribeJ (�� � �Z� - 6 7 6 y
CONTACT NAME PRIMARY PHONE
E-MAIL ADDRESS
G /f S c-c�� c 7 7 � - �`t Z o � c.,c�S • ►•w•k., . C�..
LENDER N�t`tE
MAILIN�ADDRESS CITY,STATE,ZIP
� � : 1 � • • �
EXISTING USE �I RL 13+-�� �-Il�+� PROPOSED USE (�$'��C► �C,C,v� � �
EXISTING ASSESSED/APPRAISED VALIIE 7$ VALUE OF PROPOSED WORK 7$ ' �O� D D O
SPRINKLERED BUILDING? ❑ YF,S �NO FIRE SIIPPRESSION SYSTEM PROPOSED/RF,QUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER �"LAKEHAVEN ❑ ffiGHI.INE O TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER LAKEHAVEN ❑ HIGHLINE ❑ PRNATE(SEPTIC)
: � i
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AREA DESCRIPTION EXISTING PROPOSED TOTAL
S .FT. S .FT. S .FT.
SASEMENT
FIRST �1 5 S,�
SECOND
i o7�
THIRD
\ �
FOURTH ' .
ADDITIONAL FLOORS(DESCRIBE) ��f�
DECK(CO; , , . C �(J
w �
..,..� � °'F� �r- # '''..:.,. �y � .� �....... �` ... ... ��L!.. �,. � t3� . �•7��
GARAGE CARPORT❑ '
1 �u
cusruro rxoeoseo rar�v. ,rat;' � : �u.�Roroacv ar,�� r�z
NUMBER OF FLOORS �jr +�=�� � . �
... . �� � .:, �r �� - �
••NEWHOMES ONLY`* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ �Z� J�'�' '
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Indicate number of each type of fueture to be instal(ed or relocated as part of this project. Do not include existing fixiures to rem.ain.
MECIiA1Vl(:AL
Value of Mechanical Work $
A[R HANDLING UNITS EVAPORATIVE COOLERS � GAS LOGS REFRIG.SYSTEMS
BBQS FANS HOODS�c,�,r;�� WOODSTOVES i
BO[LERS '�! FIREPLACE INSERI'S / RANGES MISC(Describe)
COMPRESSORS I FURNACES _� GAS WATER HEATERS �'
DUC1'S �_ GAS PIPE OUTLETS {
PLiIb�ING �
�3 BATHTUBS�o��n,e/snow�rcom�� _� SHOWERS 3 WATER CfASE1'S�roa�y MISC(Describe) �
� DISHWASHERS � SINKS DRINKING FOUNTAINS I
GAS PIPE OUTLETS SUMPS RAINWATER SYST �
____�_ WASHING MACHINES URINALS 'Ti HOSE BIBBS I
LAVS�aattvoom sinke� VACUUM BREAKERS ELECTRiC WATER HEATERS
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I cert�fy wtder penaity oj perfury that the ttiformattort furnished by me is true and correct to the bes!of my knowledge,and further, that I �
am authorized 6y the owner of the above premises to perjorm the work jor which the permtt appitcatton {s made. I further agree to hoid
harmless the Ctty oj Federal Way as to any claim(including costs, expenses, and attorneys'fees tncurred in the trtvestigatton and defense of i
such cla{� which may be made 6y any person,{ncludirtg the undersigned,and jtled aga{nst the City oJ Federal Way,but oniy where such cla{m
artses out of the roitance of the dty,includ�ng its officers and employees,upon the accuracy ojthe information supplied to the ctty ars a part of i
thts applicattort. I
� 1
NAME/TITLE DATE S
(signaturel �Title�
RELATIONSHIP TO PROJECT �pwner j�Agent o Contractor ❑ Architect ❑ Other
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Butleun#100—Januu},��2p05 Page 2 of 4 k�I-[andouts�I'ermit Application
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RESIDENTIAL COMMERCIAL
NEW RE.SIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet �Z JO Se►vice or Feeder Each Add'n
(First 1300 ft�-$104.50;Each add'n 500 ft�-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
� (Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00
� ❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601-800 amp 398.50 . 168.50
�o/ ❑ 801 - 1000 amp 486.50 203.50
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� �� NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
❑ 401 -600 amp 193:00 96.00
❑ 601 -800 amp 247.00 132.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 353.50 264.50 Seruice or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ 0 to 200 amp $87.00
❑ 201 -600 amp 141.00 ❑ #of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 cucuits-$89.00;Add'n circuits,$7.00/ea)
, ❑ #of circuits to be added/altered COMMERCIAL/INDUSTF2IAL PLAN REVIEW
(1-4 circuits-$69.50;Add'n circuits$7.00/ea) $89.00 plus 35%of PeiIIlit Fee
❑ Seivice- 1,000 amps or�eater
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBII.E HOMES
❑ Seivice or feeder only $69.50
; ❑ Secvice and feeder $113.50
TEMPORARY SERVICE
� MOBII.E HOME/RV PARK Residentia
i 1/Muiti-Famiiy $61.00
❑ #of seivice or feeders
(First service/feeder-$69.50;each add'n-$45.00) Commercial/Industriai Seruice or Feeder Ampacity
❑ 0- 100 amps _ $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
(� r #of Thermostats ❑ #of Signs
(First-$52.00;add'n-$16.00/ea) (First sign-$52.00;addh si�$24.50/e�
� Low Voltage ❑ Swimming pool/hot tub................ $87.00
Square Feet to be Served by system(s) (Includes additional circuit,if required)
¢l Fire Alarm System ❑ Yard Pole meter loops..................... $104.50
❑ Security Alarm System ❑ Additional Plan Review $104.50/hour
❑ voice Cabling (for modified submittals)
❑ Data Cabling ❑ Automation Fee on all Permits .. $5.00
❑
(Per System(s) 1•�2500 ft�-$61.00;
Each add'n 2500 ft�-16.00) 'Per WAC 296469I0(5/(b/(ds QJ
Bul(etin#100-January 7,2005 Page 3 of 4 k�Fiandouts�Permit Application