05-106117 r � �;,,o �� NI'T`(DEVEI.U��vi�.,� ,, ,;��cN"T � � — �!. ��� J.� �
���,��P " O� �� ZOO9 PE RM IT SF MF CO ME EL PL DE EN FP
33325 S�TI AVENUE SOUfH•PO BOX 9�
FEDERALWAY,WA 98063-9718 APPLI CATI ON � �
253-83rr2607•FAX 253-895-2609
mww.ciLuoffederalmau.mm
The o! is ired t ormallon-an te itcallon wiU not be ted. Piease t (ire irtl�►or
.�. �. �
9ITE ADDRESS ^/ � _ I G �.'� � SUITE/iJNIT�1
ASSESSOR'8 TA%/PARCEL#f - � _ , _ LOT SIZE/s�
I.EGAL DESCRIPTION(e.g.Acme Estates.Lot 1)
wu�n�ote y�yeSQ���i���o
•• •• •
TYPE OF PERMIT ❑BUII.DING ❑ PLUll�ING ❑ MECHANICAi.
❑ DEMOLIITON ❑ ELECTRIC.AL ❑ EMGIPiEERING �(FIRE PREVENTION SYBTEM
/ �
PROJECT DEBCRIPTION(Proutde detailed descrtption of work included on this nermit onlu)
�r e �: ��-� p�t j� � i>>��i�D
PROJECT NAME(Name of Business or Oumer Last Name) ��„/T)_�L'���
•• •• •
PROPERTY N �rtt0
owivER �p C�f 1 C (' �� -
MAII,ING ADD Cf1Y.STi17E
�i c►� � ,
CONTRACTOR �� ��+ME n�ru NnME oFencE rr►or�
v� C ca�a s a�a�� ��3Gc� 35`7 - Cac�j
G ADD C .SfA1E.ZIP CIIL PHONE
�_d l9'� I L�1 S' �3f�D )�2 -��.5
C OF FEDERAL WA BUSINESS LICENSE NUMBER EXPIRAITON DA7E FAX N[JMBER
�. a-�s� -l_ Q � � L 3-B L I�Z '31 �a�� c � -
��V�^�� .J1I�/y�� ��i � �disd dth e�ch�PPucatlon) p /�N D/
1
�, � �. �
a�c�r �o��N� ��� o�,���o�
S �' !,%i ` c.� ( ) -
MAQ.ING ADDRESS C11Y.STA7E.ZIP CEId.PHOI�
� � -
REIA170NSHIP 7'O PRQJE(.'T FAX NUMBER
❑Architect ❑Tenant ❑Agent ❑ Other(DescNbe).��/��Crjt�� ��O) � -� `7
CONTACT N P Y PHONE � ADDRESS
� t� �� � S�� - 0/� c►� ��vJ C`� I
I.EDmEIt Per Rcw 1s.a7.oss: tenae.!n}'ormacton is r'^"� �fi�jJ
r+squtred;f po,j�ct oot�e�cc�e�ecls Ss.000 � � (
MAII.ING ADDRESS C11Y,STA7E,ZIP PHONE
l � -
� � : � �• •
ESISTII�iG II8E � PROPOSED IISE
ESISTIIVG ASSES.SED/APPRAISED VALIIE $ VALUE OF PROPOSED WORH $ CJ v
SPRIIVRLERED BUII.DING? ❑YES �O FIRE SUP'PRESSIOPi SYSTEM PROPOBED/RE9UIItED? ❑YES �(NO
WATER SERVICE PROVIDER ❑ LAHFSA ❑ HIGHI INNE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LASEHAVEN ❑HIGHI.INE ❑ PRIVATE(SEPTiC)
/�/� � — 7�-a-�i�e.c� 7`� � �7'C.
,
. . . � . �
RESIDENTIAL COMII�RCTAL
NEW RESIDENTIAi.SERVICE NEW COMMERCIAL/II�DUBTRIAL SERVICE
❑ Single Family Square Feet Seruice or Feeder EachAdd'n
(Flrst 1300 ft2-$104.50;Each add'n 500 ft2-$33.50) ❑ O to 100 amp $113.50 $69.50
❑ Detached outbuffding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00
❑ Detached outbutlding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 0 gpl-800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMII.Y(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 �,�gED COMMLRCIAi./II�iDU3TRIAL
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Seruice orFeeders
❑ 0 to 200 amp $113.50
Ai.TERED SII�iGLE/MULTI FAMII.Y ❑ 201 -600 amp 264.50
Seruic�e orFeeder � �1 - 1000 amp 398.50
❑ over 1000 amp 443.50
❑ 0 to 200 amp $87.00
❑ 201 -600 aznp 141.00 ❑ #of circuits to be added/altered
❑ over 600 amp 212.50 (1-5 circuits-$89.00:Add'n circuits,$7.00/ea)
❑ #of circuits to be added/altered CO11Q[ERCIAL/II�iDUSTRtAL PLAN REVIEW
(1-4 cfrcu�ts-$69.50;Add'n dreutts$7.00/ea) $89.00 plus 3596 of Permit Fee
❑ Service- 1,000 amps or geater
❑ Mast or meter repair $52.00 ❑ Medical/EducaUonal/InstttuUonal Facility
MOBILE HOMES
❑ Service or feeder only $69.50
❑ Service aad feeder $113.50
TEMPORARY SERVICE
lY[OSII.E HOME/RV PARK Residential/blulbt-Fam{ly $61.00
❑ #of servtce or feeders
(First service/feeder-ffi69.50;each add'n-$45.00) Conunercial/IndusMa[Service or Pleeder Ampqc{ty
❑ O-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/E(,�UIPMENT
❑ #of Thermostats ❑ #of Sigps
(FYrst-$52.00;add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
❑ Loa Voltage � S�vimmiaS Pool/hot tub................ $87.00
Square Feet to be seived by system(s) '// ,S� (Includes additional circuit,if requfred]
�re Alami S�stem ❑ Yard Pole meter loops..................... $104.50
'C� Security Aiarm Syst`'m ❑ Additional P1an Reviea $104.50/hour
❑ Voice Cabling (for modtfied subffittals)
❑ Data Cabllng ❑ Aytomation Fee oa all Permits .. $5.00
❑
(Per S�stem(s)1�2500 ftz-$61.00;
Each add'n 2500 ft�-16.00]•P�rWAc z96-46-s1o(5Ilbll«W
Bulletin#100-January 7,2005 Page 3 of 4 k�I-Iandouts�Pernut Application
-. •.-
AREA DESCRIPTION E%IS'1'II�T(3 P'ROPOSED TOTAL
.FT. .FT. .FT.
BASEMENT
FIRST
SECOND
T�IIRD
FOURI�I
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS ��mo ricoeo� mr.w mrec�nrea rorwcranoems rar.n.a
""NEW HOMES ONLY" NUMBER OF BEDROOMS ESI'IMATED SELIdNG PRICE $
Ind�cate number of each type o,f,jixture to be tnstalted or relncated as part of this project Do not fnclude exisfireg f�xtures to remaln.
bSECAANl:AL
Vatue of Mechantcai Work $
AIR HANDIdNG UNiTS EVAPORATiVE COOLERS GAS I.OGS REFRIG.SYSTEMS
BBQS FANS HOODS IcAmmc,c�atl WOODSTOVES
BOILERS N7REPIACE INSERI'S RANGES MISC(Describe)
COMPRESSORS N�lRNACES (}AS WATER HEATERS
DUCTS GAS PIPE OVCLETS
PLUD�ING
BATf�fCJBS(o�1ut/showcrcom6ol SHOWERS WATERCIASET'S�m�kU MISC(Descrlbe)
DISHWASFIERS SINKS DRINKIIVG FOUNfAINS
GAS PIPE OU'ILETS SUMPS RAINWATER SYST
WASHING MACHINFS URINALS HOSE BIBBS
IAVS�sau,room�uks� VACUUM BREAKERS ELECTRIC WATER HF.ATERS
� •
I cert�J�weder penaity oj perjury that the iqjorneation,furntshed by me is true and oomcct to the best of my knotuledge,and jurther, that I
am authortaed by the owner oJ the diove premises to orm the uwrk jor which the permit applicatton is made. I furthar ayrce to hold
harntless the Ctty of P1�dernl W�q/as W w1y cicdm ncl ing costs.acpenses, and attorneys'jees�rcd tn ihe inoesHgatfon and d41�e�4f
such clatm,►,which may be made 6y a�q/ n,i i the undersigreod,and,�iled qgainst the GYty qf Fbderal Way,but only urhere such claim
arlaes out qf Lhe relianoe of t udtng artd emPloyees.upon the accuracy of the injormation supplied W ihe city as a pnrt qf
this applicatinn.
NAME/TITLE DATE ✓ ��`�/ ���
(S ) ('[IUe)
RELAITONSHIP TO PROJECT ❑ Owner ❑Agent ❑ Contractor ❑Architect ❑ Other
FOR OFFICE II8E OMLY
❑NEW ❑ADDITION ❑ALTERATiON ❑REPAIR ❑TENANT III�'ROVE11�iT
BIIILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑PO
ZONII�iG DESIGNATiON CIiANQ�E OF USE? o YES ❑Pi0
NEW ADDRESS RE9UIRED? ❑YES ❑li0 UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? ❑YES ❑NO DE�[O PERMIT RF.gUIRF.D? ❑YES ❑li0
Bulletin#100-January 7,2005 Page 2 of 4 k�Handouts�Pemut Application