09-103844 r —�9 - � � ��`��
� �,n.oF�E�I��VE� pERMIT SF MF CO ME EL PL DE EN FP
Federal Way
�oM�N�DE��PM��R��E2 zoo� APPLICATION � �
253-835-2607•FNL253-835-2609
u�ww.cit o ecieralwa.com
IlY �
£05 �tU�'�R'�'Y
.
SITE ADDRESS (+ `
�`'1`� .7., �� !�{�/L. �7 • ~�c��'(`�I �,f�ls�- L U i1C1 7
SUITE/UPiIT# � ZOMNG ASSESSOR'S AX/PARCEL#
� � � � �� � — � C% : ,�i
PROJE�C�` , , — —
NAME OF PROJECT � i-
(Tenant or Homeowner Name) L��- 1 V„ � �- .— L� � C` fC� � '
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING [�FIRE PREVENTION
�
,t t '-i"f'i.. �';"�
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit oniy
������
NAME . . J . . � PRIMARY�PHONE
PROPERTY OWNER �;�, + ° ! ' c ( ) -
�� ��u�l � w . V� , .� .
MAILING ADDRESS.CI ,3TATE,ZIP E-MAII,
;l i�� -; ,L. � �k-�1�, �,�.�FI 1:�. " ,I iti,
OWNER IS ALSO: � CONTRACTOR � APPLICANT � � PROJECT CONTACT
NAME PRIMARY PfiONE
� ✓ �,rl� F_I�c-�:d�. ( ' � ) 'z - ' e�-�
CONTRACTOR �DRE3S,CITY,STATE,ZIP FAR
�� .i...�. '� i"�%i ��� ��J� - '��"L��
WA STATE CONTRACTOR'S LICENSE M E7CPIRATION DATE FEDERAi.WAY BUSINESS LICENSE X
ki �t '> 7 3 ,, / 1� �'' '11
NAME PRIMARY PHONE
APPLICANT < 1.- �j� � �S`� - <i�'-t-'`J�:,
ING ADDRF,SS,CITY,ST E,ZIP FAR
7 w• '� 1 �a �� r,SCy '�t-s ''?
��� L C r'.t-- N vJ . li � � 4� -<;, �
PROJECT CONTACT NAME PRIMARY pHONE
(The individuai to receiue and `� a ' 'r__ct�'�"� ( ) -
respond to all correspondence MAILING ADDRES3.CITY.STA , iP Fna
concerning this appiication) � � _
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
� � -
PROJECT FINANCING N�
� OWNER-FINANCED
Required for projects with
ualue of$5,000 or more M��NG ADDRE33,crrr,STATE.ZIP PRIIKARY PHONE
lacwis.2�.oasl � � _
I cert}fy under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the ir4formarion submitted in support oJ this permit application is true and correct.I certi,fy that I will comply
wtth all applicable Clty of Federal Way regulations pertaining to the uwrk authorized by the issuance oj a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance �uith iceal, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless ihe City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the iwesrigation and defense of such clairr�, iuhich may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance oj the city, includtng its o„Q icers and employees, upon the accuracy of the
injormation supplied t t e city as� qrt qf,this application.
� � ��
�e
SIGNATURE: ' 'f `f"'"✓ , DATE ��Y����
PRINT NAML: I ,=_� 1J�'=d
Bulletin#100-4/21/2009 Page 1 of 4 k:�IIandouts�Pernrit Application
I
1
CHANICAL FIXTURES
Va1ue o Mechanical Work$ (A COPY OF OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or ated as p .�of this project. Do not inciude exisring fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OLITI,E'I'S O'PHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS�comm�r�t�)
BOILERS FURNACES HOT WATER TANKS�Gas)
COMPRESSORS GAS SETS GERATION SYST
DUCTING GAS PIPING WOOD VES
PLUMBING FIX RES
Indicate number of each type of fixture to be instal or reiocated as of this project. Do not include existing fixtures to remain.
BATHTCIBS(or1Lb/ShowcrComho) LAVS�Hana s��s> TOILET'S WATER PIPING
DISHWASHERS RAINWATER SYST URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINK �tcit�n��/utmty) WATER HEATERS(eiecm�)
HOSE BIBBS SUMPS ING MACHINES TOTAL FIRTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF ERISTING IIKPROVEMENTS
�'�t�1 C1�. �`J �
EffiSTING/PREVIOUS USE LO'C SIZE(In Squere Feet) Effi3TING FIRE SPRINHLER SYSTEM? PROPOSED FIItE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXI G PROPOSED TOTAL
FOR OFFICE USE
_..........................._.......................................................
BASEMENT
...........................................,.....,......,........................,......,.....,.....,....................._........................................,.............
FIRST FIAOR(or Mobiie Home)
.........................................,.........................,.....,..................,..........................................................................
SECOND FIAOR
_................................................................................................................................................................................
COVERED ENTF2Y
_..............._.._.........................................................................................................................,............_......
DECK
GAF2AGE ❑ CARPORT ❑
�...........................................................................................................................................................................
OTHER(describe)
Area Totals �IN� �o�e� T��,.
.......................................................................................................................
**NEW HOMES ONLY*•
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in uare Feet Occupancy Group(s) e Stories �ditional Information
NEW BuILDIIVG
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in uare Feet Occupancy Group(s) e Stories ��tional Information
"I'OTAL BUILDING
TENANT AREA OPiLY
PROJECf AREA ONLY
Bulletin#100-4/21/2009 Page 2 of 4 k:�Handouts�Pemvt Application
� ELECTRICAL
RESIDENTIAL COMMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet :
(incluc�ing attached garage): � l s�Seruice/Feeder Additional Feeders
0- 100�mp x$131.50 x$ 80.00
FEES: First 1300 ftz-$121.00; 101- 200 amp x$163.00 x$103.00
Each,additional 500 ft2-$39.00 201- 400 amp x$305.50 x$i20.50
NEW MULTIFAMILY (3 units or more) 401- 600 amp x$356.00 .x$142.50
Is�Seruice/Feeder Additionai Feeders 601- 800 amp ` x$460.50 �;> x$195.00
0- 200 amp x $131.50 X $ 39.00 g01-1000 amp x$562.50 ��' x$235.50
201 -400 amp x $163.00 T x $ 80.00 Over 1000 amp x$613.00 /f x$327.00
401 -600 amp x $223.00 x $1 ll.00 J`�
,
601 -800 amp x`,$285.50 x $152.50 Over 600 volts surcharge /�/ x$103.00
Over 800 amp x $'�08.50� x $305.50 °� /f
/
ALTERED SINGLE'`�r MULTI FAMILY ALTE � COMMERCIAL
� ,
� ,
1 s�Seruice/ eeder Additionai Feeders -��s`�N e/Feeder Additional Feeders
0- 200 amp x 100.5d x $ 39.00 0- 200 amp =r x$ 1.50 x$103.00
201 -600 amp $163.00 `� x $ 80.00 ZO1- 600 amp , x$30 .50 x$142.50
Over 600 amp x $245.50 x $111.00 601-1000 ar1�p� x$460. 0 x$235.50
\ Over 1000 amp x$513.00� x$327.00
Added or Altered C' cuits
1-4 circuits$80. ;each additional$8.0 Added or Altered Circuits ti
1-5 c�rcuits$103.00;each additional$8.d0
Mast or meter epair $60.50 '•
Mast or meter repair $111.00
MANUFACTURED HOME PLAN REVIEW FEES
Se ' e or feeder only x $ 80.00 0
$103.00 plus 35/o of Permit Fee;Plan Review required for:
Se 'ce and feeder x $131.50
❑ New,or alteration to, service of 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
Plan review for modifled submittals $120.50/hour
NIISCELLANEOUS SERVICE/E UIPMENT
LOW VOLTAGE TEMPORARY SERVICE
� F�re Atann System _ 1G�Seruice/Feeder Additional Feeders
Security Alarm System
❑ Voice/Data Cabling 0- 60 amp x $ 71.00 x $ 32.00
❑ Other � � 61- 100 amp �'�c�$ 80.00 x $ 39.00
Area to be served by system: �j ���
1S1 2,500 ft2-$71.00;each additional 2,500 ft2-$18.50 101-200 a121p X �3.50 X $ 51.00
201-400 amp x $120.T�0 x $ 60.50
#of Thermostats 401-600 amp x $163.50���._ x $ 80.00
First$60.50;each additional$18.50
Over 600 �p x $183.00 x $ 92.00
#orsigns **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$ioo.so For fixtures or fees not listed contact the Permit Center at
Ditch cover/inspection only x$120.50 253-835-2607
Bulletin#]00-4/21/2009 Page 3 of 4 k:�I Iandouts�Permit Application