03-103994 ..._.'"N„.. IVED CONSTRUCT J PERMIT APPLICATION q
CITY of APPLICATION NUMBER: #3 - O_
Federal Way AUG 2 7 20,c1 APPLICATION NUMBER: - -
��-�x (APPLICATION NUMBER: - -
"The folltAh/i Wrmation-Please print(in ink)or type*'
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. 19931
= " a. PROPERTY INFORMATION
SITE ADDRESS: ) III S • r�� ASSESSOR'S TAX/PARCEL #: -
1
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
1 PROJECT INFORMATION
TYPE OF PROJECT(This application): ❑ BUILDING o PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING RE PREVENTION SYSTEM
fj PROJECT DESCRIPTION (Provid ta'led descriptio
fir_ L t
I
PRO • ,
JECT NAME: el L
_, _` ::•-PEOPLE INFORMATION.
f PROPERTY OWNER: NAME: DAYTIME PHONE
( )MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
� I
CONTRACTOR: NAME: � 7ME ONt�- Q.43,
MAI�(N}C�•D SS(STTREAPT-ecii.45(911 (
STA :ZIP): �� . EVENING PHONE'
CITY aDE L W Y BUSINB1.: 1 (
f FAX NUMBER:
- ( ) - I
CONTRACTOR'S REGISTRATION NUMBER: w i EXPIRATIODATE:
(copy of cad required) r ) 5/C)3a)
APPLICANT: ( NAME: / ���\ �ei/ �� a1610(:)24'3/r
IY/�])��t-
MAILING ADDRESS(STREET ADORE ;CM),STATE,ZIP): EVENING PHONE'
( )
RELATIONSHIP TO PROJECT: j FAX NUMBER:
i
0 ARCHITECT O TENANT ❑ OTHER( DESCRIBE): ( ) - i
E-MAIL ADDRESS: I
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER O APPLICANT a CONTRACTOR I
-■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? a YES O NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES O NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE O TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: O LAKEHAVEN O HIGHLINE ❑ PRIVATE(SEPTIC)
{
**NEW RESIDENTIAL CONSTRUCTION 01 *
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
,. • ■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL: _
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL j
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGES) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
{
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the Information 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 daim(induding costs,expenses,and attorneys'fees incurred In the
investigation and defense of such claim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim a ' s out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the d ,a's part of this application. \
NAME/TITLE: DATE:�_�3 ..0
/ `
-
o PROPERTY OWNER o AP CANT IL'CONTRACTOR
FOR.OFFICE.USE;,ONLY:
& EW . . '0'w-AD-DITIotetlki 0 ALTERATION ' REPAIR , ; a TENANT IMPROVEMENTd "',
-CENSUS:`CODE s��. .1?70 _ '-�LOTSIZE47.41 �'.-� tic ��'�V *, ,:%---i.
.
ZONING DESIGNATION::' ¥_- wl _ =BUILDING SHELLK'ONLY?Yo YES a NO
COMP PLAN DESIGNATION ; ... - ..BASIC PLAN? ;,,_❑YES ' °o.NO,�
`SECTIONkF s3_ TOWNSHIP, !RANGET i W' NEW ADDRESS REQUIRED? ;: .`AYES 0 NO
CHANGE OF USE?. s - a YES:',°-1 i NO PLATTED LOT? ' 17 YES.=;_oyNO ,�'�„Y�.w��y -
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.dtvoffederalway.com
Conction Permit Fee Calculation Ilbeet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY C AFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL . ,-T BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
TABLE A
TOTAL VALUATION FEE FACTOR
(1)$1.00 to$500.00 (1)$30.00
(2)$501.00 to$2,000.00 (2)$30.00 for the first$500.00 plus 54.00for each additional$100.00or fraction thereof,to and Including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$90.00 for the first$2,000.00 plus$18..00for each additional 51,00000or fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$504.00 for the first$25,000.00 plus 113.00 for each additional$L000.00 or fraction thereof,to and
Including$50,000.00
(5)$50,001.00 to$100,000.00
(5)$829.00 for the first$50,000.00 plus 19.00 for each additional$1,000.00or fraction thereof,to and
including$100,000.00
(6)$100,001.00 to$500,000.00
(6)$1,279.00 for the first$100,000.00 plus SZOO for each additional$L000 00 or fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$4,079.00 for the fist;500,000.00 plus$6.00 for each additional$1.000.00 or fraction thereof,to and
including$1,000,000.00
(8)$1,000,001.00 and up
(8)$7,079.00 for the first$1,000,000.00 plus$4.50 for each additional 11000,00 or fraction thereof.
Bold number Is the base fee for the specified Increment
Italicized,underlined number Is the fee-ver additional sne ffred Increment
—
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District#39 surcharge,commerdal only.
Add$4.50 for WA State Building Code Council,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are calculated separately**
■ BUILDING
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
. . . _ ■ MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION: r j( )L)
FEE FACTOR FROM TABLE A: umber: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
IN PLUMBING ,
Base Fee Number of fixtures
$26.00+{ X$9.00/fixture}= (8)Estimated Permit Fee
Estimated Permit Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total (Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)= (11)
■ ELECTRICAL
TABLE B
NEW RESIDENTIAL SERVICES MOBILE H ES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $57.00 _ft of Thermostats(First-$43.00;add'n-$13.00ca)
(First 1300 ft'-$85.50,Each add'n 500 ft -127.50) _Service and feeder 193.00 f of Low voltage fire or burglar alarms
iquarc Feet: First 2500 fl2-$50.00:Each add'n 2500 ft`-$13(i0
_Each outbuilding or garage S35.50 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _tf of service or feeders * Per WAC 296-46-910(5)(b)(i R ii -
_Each outbuilding or garage $57.00 (First service/feeder-157.00;Add'n service/ _ff of Signs(First sign-$43.00;add' gn
(Inspected separately) feeder-$37 each) - $20.00 each)
Swimming pool,hot tub,s. $85.50
I -
Yard Pole meter loops $57.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCI• /INECUSTRIAL
(Includes three units or morel tered Service or Feeders
Service Feeder Amps Service or Add'n 0 to 11 5 91:J1)
Up to 200 amp $ 93.00 $ 27.50 Feeder _20 „600 216.50
_201 -400 amp 115.50 57.00 0 to 100 1 93-00 5 57.00 01 -1000 12650 l 4
_401 -600 amp 158.50 78.50 _101 -200 115.50 72.50 over 1000 363.00
_601 -800 amp 202.50... 108.50 _201 -400 216.50 85.50 _f of circuits
_Over 800 amp 289.50 216.50 401 -600 252.50 101.00 fI-5 circuits-$72.50,Add'n circuits,S6 ear
ALTERED SINGLE/MULTI FAMILY _601 -800 326.50 138.00
(When inspected separately from the services.) _801 -1000 399.00 16 . 0 TEMPORARY SERVICE
Service or Feeder _Over 1000 434.50 2 .00 Residential/Multi-Family/Commerciai/Industrial
0 to 200 amp $ 71.50 _Over 600 volts surcharge :72.50 0- 100 $ 57.00
_201 -600 amp 115.50 _Mast or meter repair7....78.50 _101 -200 72.50
_over 600 amp 174.00 _201-400 85.50
_Mast or meter repair 43.00 _401 -600 115.50
a of circuits _over 600 125.00
(1-4 circuits-157.00,Add'n circuits$6 ea)
If a new or altered commercial service is 200 amps or greater,or a new or altered residential service is greater than 400 amps,a plan review is required.Fee is 35%of
permit fee+$72.50.Add'I plan review for other submissions is$85.50/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
i 1 ! !
t
� `
- ;
L
/ 1 f i 1
TOTAL.COLUMN(D):
-
- I
Total Column(0)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $72.50 +( X.35)_ (13)
■ DEMOLITION
Estimated Permit Fee: ( 4)
Bond Amount:(15)
■ ENGINEERING - -- ..
Estimated Permit Fee (16)
Bond Amount: (17)
U OTHER FEES
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23)
Total (Pages One&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) = (24)
Bulletin #100-December 23, 2002