05-103838 i � •
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Federa�way P�RM T ���vr►� � � .Q ..� S � g
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33J�5 8+M AVfiNUE S0t/7f1•PO gOX 9718
FEDERAL WAY,WA 9806J-971 d A P P L I C AT I CT� � �� D / /
� Y53-835-Y607•£AX 253-635-2609 /
uxuro cifcn/fedemlwoy eom ,(
CITY OF FEDERAL
J
The oilowi is uired in ormallon-an{n,co Iete a iicano�B�� ted p��e rint le ibi �n in or
•� • � � - •
SITE ADDRFSS _ �j �Y l� ���(_
9 SUITE/IJDTIT�
ASSESSOR'S TAX/PARCEL� _ _ _ _- _ _ _ LOT SIZE(s�
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1 J e
(Attad�separcte fa9elar k�gehY kgc�deaaiPNm1
•� • ' •
TYPE OF PERMIT C�BUILDING ❑ PLUMBING O MECHANICAL '
❑ DEMOLITION ❑ ELECTRICAL O EPiGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DFSCRIPTION(Proaid'e�etailed descripteon of work ina(uded on t ' �t nI
� �r�/ . r �
Z��u i� ';, �ilGi �— _ t��f�PL� �- ;
' 2 � � ��� t� � � -�z::J
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PROJECT NAME(Name of Business or Owner Last Namej � S�J V y7L�.:..! -
• • • - •
PROPERTY NAME �
PRIMARY PHONE
OWNER (., T' �Zve; I L - .L(-�
MAILINO ADDRESS � �
�,/,avl'1. CITY,STATE.Z[P
�i.,; . ���,5` ��a-?lG� v�/ R t�/v5
CONTRACTOR �MPANY NAME APPLICANT NAME OFFICE PHONE
MA[I�,IN ADDRESS T NO� CITY,3TATE�P u� � CELL Pf{ONE Z� LG� �s
Y4� V.�N�.� � "S 7 V� �_��! L-L�
. G t-�-it , r.�,�g g.�.,5 (:,z.�e: ) ,
C1TY OF FEDERAL WAY BUSINESS L[CENSE NUMBER EXpIRATION DATE .- FAX NUMBER
2 a -� �� v � 6 � �-s r, IL �3� � v �2v� � 323 676'Z
CONTRACI'OR5 RF.�[3TRAT[ON NUMBER(eopy of oud reqnired with eaeh applleatioa EJ(PIRA'fION DATE
� L� � � � � �� � 1'� � � S �L`/ �o '�—
APPLICANT COMPANY NAME APPI.[CANT NAME OFFICE PHONE
� ` +.� C:c�,} . � 2� ) 3 2 3 - 6 Fo S6
MAIUN ADDRESS N p CITY,STATE,ZIP — CELL PHONE
L� t��•—� � � ,8�� 2 c.�lp q.�J�ci (tJ� ) 77r3 - 7SLv
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect o Tenant ❑Agent ❑ Other(DescribeJ � � _
CONTACT NAME � PRIMARY pHONE - E-MAIL ADDRESS
'i= n �C. � o `77� Z #e � GK.LSC.K���l'lo.0
� �W'�
LENDER �E
MAIUNQ ADDRESS G1Y.3TATE,ZIP
� � : 1 � • • �
ERISTING USE � PROPOSED USE I,�/.k;L ��,G r+-, � T
EXISTING ASSESSED/APPRAISED VALIIE 7$ VALUE OF PROPOSED WORK � t�I�L'�'��
SPRINKLERED BiTILDING? ❑YF.S �.NO FIRE SIIPPRESSION SYSTEM PROPOSED/I2F,QUIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER �.LAKEHAVEN � HIGFiLINE p TACOMA p pRI�/ATE(WELL)
SEW,ER SERVICE PROVIDER LAKEHAVEN ❑ ffiGHLINE ❑PRIVATE(SEPTIC)
. , :
�
•• •� -
AREA DE3CRIPTION EXISTING PROPOSED TOTAL
S .FT. S .FT. S .FT.
BASEMENT '
i
FIRSf ,
� � � � Z�`
SECOND
�L��
THIRD
FOURTH ' .
ADDITIONAL F�RS�pESC,}2IBF) . � �
s � " y
M_ 'k. . �, +�� -. �..�'.1' � . . .
4
DECK(COV�Ei2ED?) ` • . . ,. / .i_
GARAG� CARPORT❑
�� �.
NLIMBER OF FLOORS �Ofo raoroseo ror�u. _ _ ; �..................�, _..._......,_.._,�.
�J.._.��...:.
••NEWHOMES ONLY•• NUMBER OF BEDROOMS �� ESTIMATED SELLING PRICE $ J vJ o
► •
Indicate num6er of each type of fixture to be insta((ed or relocated as part of this project. Do not include existing fudures to remain.
MECFfA1VICAL
Va(ue of Mecfwnical Work $
A[R HANDLINa UNITS EVAPORATlVE COOLERS � QA3 LOGS REFRIO.SYSTEMS
BBQS FANS HOODS�cemmaci.q WOODSTOVES
BOILERS FIREPI.ACE INSERIS � RANQES � M[$C(Describe)
• COMPRE330RS �`` FURNACES �_ GAS WATEIt HEATERS
DUCT3 � QA3 PIPE OUTLET3
PLUMBING
� BATHTUSS(or7Lb/ShawerComho) � 3HOWERS � WATER CLOSEI'S�rou�q MI3C(Describe)
—� D[SHWASHERS �_ SINKS DRINKINQr FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER 3YST
�— WASHING MACHINES URINALS � HOSE BIBBS
LAV3�a.m,00ms� VACUUM BREAKERS ELECTRIC WATER HEATERS
� •
I cert�fy under panaity of perJury/that the iqformation furnished by me is Gue and corrsct to ths best of my knowledge,and further, that I
am authortzed by the owner oj the arLovs premises to perform the work jor which the perntit appilcatlon is made. I further agree !o hoid
harmless the GYty of Federa[Way as W any cladm(Inciuding costs, expenses, and attorneys'jees incurred in ehe[nvestigatlon and dsjense oj
such daimJ,which may 6e made 6y any person,including the undersigned,and itled against the Ctty oj Federal Way,but oniy where such alaim
arises out of the reltance of the ci[y,tnciuding its officers and employees,upon the accuracy of the ir{jormaHon suppLied to the ctty as a part of
this appLtcation.
NAME/TITLE � �►�-� J', � /
wl .)A-�{a(._ DATE ��I 1 v �
(Signatun� (Titte)
RELATIONSHIP 1`O PROJECT ❑ Owner ❑Agent ❑ Contractor ❑Architect O Other
BulleLn#100—Januaiy 7,2pp5 Page 2 of 4 k�Handouts�Permit Application.
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� � • • •
RESIDENTIAL COMMERCIAL
�E7 NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAI.SERVICE
�.Single Femily Square Feet �55� Service or Feeder Each Add'n
(Firat 1300 ft�-�104.50;Each add'n 500 ft�-$33.50) ❑ 0 to 100&mp $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
� ❑ 801- 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Seruice 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/INDUSTRIAT.
❑ Over 800 amp 353.50 264.50 Seruice or Feeders
: ❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201-600 emp 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 emp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuita-$69.50;Add'n circuita$7.00/ea) $89.00 plus 35%of Permit Fee
❑ Seivice- 1,000 amps or greater
❑ Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
❑ Senrice and feeder $113.50
I TEMPORARY SERVICE
i MOBII.E HOME/RV PARK Res{denttaT/MuiLi-Famitg $61.00
❑ #of service or feeders
(Firat eervice/feeder-$69.50;each add'n-�45.00) Commercial/Industrtal Service or Feeder Ampactty
❑ 0-100 amps _ $69.50
❑ I01-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps - 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
� � �F of Thermostats 0 M of Signs
(First-$52.00;addh-$16.00/e� (First sign-$52.00;addh sign$24.50/e�
� Low Voltage ❑ Swimming pool/hot tub................ $87.00
Square Feet to be served by system(s) Z S S v ([ncludes additional circuit,ii required)
�Fire Atarm 3yatem ❑ Yard Pole metcr loops..................... $104.50
❑ Security Alarm System ❑ Additioaal Plan Review $104.50/hour
i ❑ Voice Cabling (for modifed submittals)
I � Data Cablu�g ❑ Automation Fee on all Permits .. $5.00
ar System(s) l•c 2560 ft�-$6 L.00;
Each addh 2500 ft�-16.00) •Aer WAC T96-�6970(5/(b/(d�iiJ
Bulletin#100-January 7,2005 Page 3 of 4 k�Handouts�Pernut Application